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HIV TODAY WORSE THAN HIV YESTERDAY?
Sep 5, 2002

Hi Doctor Little, I appreciate the fact that you give truthful answers. The question I have deals with newly infected Hiv patients today versuses patients who were infected in 1995. With all this resistance now appearing in newly infected patients, is it true that current Hiv drugs work better on individuals who were infected back in 95. Many people newly exposed to hiv find themselves with limited options from the start because they are told that they are resistant to many medications. What should these patients do? Are entry inhibitors and integrase becoming a real possibility that might allow us to live a longer life or are we just like victims in the course of an epidemic who will share similar fates to those who got this disease prior to the advent of Haart medicines? Thank you.

Haung Kim

Response from Dr. Little

While I would like to give you a more promising answer, I do think that for people infected today with significant drug resistance, treatment choices may be markedly limited. This could in fact result in a disease course more like what we saw before the availability of newer potent treatment choices. The only good news, is that individuals who appear to be infected with REALLY drug resistant virus (ie. resistant to all available classes of drugs) are still quite rare. The transmission of some degree of resistance (i.e. resistance to drugs in only one class of antiretroviral medications) has become more commonplace, but in the hands of a good HIV care provider, most of these people can be successfully treated with the medications we have available today. With regard to the newer drugs such as Integrase inhibitors, there is good reason to think that these drugs will work in people infected with virus resistant to current available treatments, the problem is that they may have limited options with which to pair their new treatments (i.e. integrase monotherapy is not likely to be a long term solution - need more potent combination treatments). So - the drugs we have today should work equally well in people infected today or many years ago - UNLESS either of these individuals has drug resistant virus. Then, the options may be more limited, but still rarely desperate, unless they have drug resistance to drugs in all three major classes - which in the case of transmitted drug resistance is still relatively uncommon.


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