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drug resistance - getting worse?
Sep 6, 2002

Hi Dr. Little,

Before I ask my question, I want to say that you have one of the most important jobs in the world. You bring people comfort and advice at a time of extreme need. I think we all feel this way about all of the experts at

Now my question

Is drug resistance becoming more and more problematic (in america)? If so, do you have any numbers showing this increase? Perhaps 25 of new HIV infections report drug resistance? Any numbers on this?

Also, I was wondering if there is any correlation whatsoever between acute symptoms of HIV and drug resistance. In other words, do you hear anything about reports of physical symptoms during actue infection followed by reports of drug resistance or harsh drug side effects in those same people?

Thirdly, and apart from the discussion of med resistance, is there anything to the theory that some HIV strains might be stronger than others? Or it is all about the particular person's immune system? Have any links of HIV transmission showed all those to carry a particular strain experience harsher acute symptoms (weight loss, etc).

Thanks again for your information and advice.


Response from Dr. Little

Yes, drug resistance is becoming more and more problematic in North America. The source of drug resistant virus comes from two patient populations - First people who are infected with HIV who take antiretroviral treatment and over time develop drug resistant virus (usually linked to poor adherence, or insufficient potency of the regimen). This virus can then be transmitted to other HIV negative people. Second, the people who get HIV infected from the first group are now a recently infected patient population who themselves have never taken antiretroviral drugs, and yet are capable of transmitting drug resistant virus on to others (since this is what they are infected with themselves). Many people in the second group do not even know that they are infected with drug resistant virus, nor do they suspect it, since they have never taken treatment themselves.

The numbers for the first group have been estimated and presented (but are not yet published). It has been estimated that at least 50% of people in the US with HIV infection harbor drug resistant virus. It may well be higher than this - but ongoing studies will firm up this number.

The numbers for the second group were just published in the New England Journal of Medicine (August 8th Issue) and show that approximately 25% of newly HIV infected subjects between 1999 and 2000 were infected with drug resistant virus (this was a predominantly male, Caucasian population whose risk for HIV infection was sex with men). This study went on to show that people infected with drug resistant virus do not respond as rapidly to treatment and have a higher rate of treatment failure than those with drug sensitive virus.

I am not aware of any information that would suggest that symptoms of acute HIV infection are linked to transmitted drug resistance. In fact, most studies have shown that regardless of whether the virus transmitted was resistant or sensitive, the viral loads are equivalent in this newly infected patient population. There is also no known link that I am aware of between having drug resistant virus and more harsh side effects related to treatment.

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