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Re resistance study findings
Feb 17, 2002

Thank you for your thoughts on the resistance study findings.

I have also asked my doctor about the study and he pointed out that the study would necessarily involve a skewed population in that to participate one would have to be someone with resistance. Because a significant amount of resistant virus (about 1000 copies) must be present before it can be tested, the study could not be a study of all on therapy, in other words. He suggested that the study added nothing new to what we already know (ie, that for various reasons a proportion of those on therapy develop resistance).

This analysis makes sense to me. Would you agree with it?

Response from Dr. Little

I am presuming that you are referring to the study presented by Dr. Richman on behalf of the HCSUS group? This study is not in any way skewed - on the contrary, this study went to great lengths to avoid just this. What they did was to assess the prevalence of resistance among those with detectable viral loads - they assumed (very conservatively) that those with undetectable viral loads had no resistance. So, I believe that this study provides a conservative estimate of resistance in the general population. Although many have long suspected that resistance rates were high, this study provides a number for the amount of resistance and makes it clear that this problem is not going to be overcome easily. I do not think it spells doom and gloom for people on therapy and doing well - this was not the intention of the study. It was to provide the best possible assessment of drug resistance in the general US population.

all treatment failed for leismaniose
resistant to almost everything

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