|How long bfore resistance develop to all drugs?
Mar 23, 2002
Dear Dr, if somebody is on a triple combo and begin to develop resistance to one of the drugs, how much time does he has for a switch in order not to have more resistance developing? Currently, the routine for viral load and CD4 count done here is on a 6 months cycle and there is no way that we could change that here as there are only a handful of hospitals serving a largely infected population. Assuming that resistance develop in between the 6 months interval, will I have a chance to react before serious damage is done? Appreciate if you could shed some light on this issue. Thanks
Response from Dr. Little
Well - the time necessary to develop drug resistance is different for different drugs and is probably also influenced by the viral load (the higher the viral load the more rapidly drug resistance may develop). You have identified a very real problem with the current management strategy where you live. In general, the recommendation is to obtain viral load testing every 3 months - one of the reasons for this is to identify virologic failure as early as possible and provide opportunities for changing therapy early rather than late. In general, I think most providers would like to switch therapy in someone failing therapy once the viral load is greater than 1000 and less than 10,000. This is a pretty big range, but viral loads will clearly be much higher in many people who wait 6 months before a follow-up viral load.
I would discuss this with your local providers and if no solution is identified, go to your local HIV community based organizations to see if some general community dialogue could be helpful in changing the current management approach in your area.
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