|Dr Little, pls answer this.
Feb 24, 2002
Dear Dr Little, is there any statistic that shows the durability of each combo therapy? I have been on sustiva and combivir for 1 year and am worried about all the resistance news that happened lately. Saw a reply by Dr Cohen on the 17th Feb where where he explained that the current optimism on the durability of HAART is that if the virus is able to mutate, it could have done so in the past 5 years and the fact they arent means they cant. So there could be a stalemate here which could last for decades as predicted my most experts. And I also seen a post by you mentioning that the threshold for the virus to create resistance is (maybe) 200 copies which again shows that if we constansly keep them under 50 copies, we will be able to manage this disease till all of us die of old age instead of AIDS. Are you still optimistic on this? Are they any ongoing research on this threshold? And are there any efforts on developing a more sensitive machine that could measure viral load to its exact count? Thanks.
Response from Dr. Little
I continue to believe that among people who are able to maintain their viral loads below the limit of detection (ie less than 50 copies), for prolonged periods of time, there is no reason that the recent data on the prevalence of drug resistance should change our optimism. I remain very hopeful that these individuals will be able to maintain complete viral suppression indefinitely - that is, there is no evidence to date that after a prescribed period of time these drugs will stop working.
For people who maintain their viral loads below 200 copies, I think the news is nearly as good - but we have less data - and I cannot be quite as optimistic that these individuals will maintain long term suppression. But this is not because the data looks bad - actually, people with viral loads below 200 appear to do quite well - it is just my opinion that they may be at slightly greater risk of relapsing or developing drug resistance over prolonged periods of time.
The bottom line though - if you are doing well on your current regimen with a viral load less than 50 for more than 1 year, I see no reason that the new more pessimistic data on the prevalence of drug resistance should change your optimistic outlook at all.
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