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Causes of resistance other than non-compliance
Sep 6, 2002

I will be starting meds next week. It is a once a day regimen so I plan on being 100 compliant with it. My question is, what else besides non-compliance causes the virus to become resistant to meds. Can it just occur naturally? I had a genotype test done and found I am not resistant to any meds. I would like to remain that way. Is this something I can have total control over? Thanks for your answer.

Response from Dr. Little

You are incredibly well-prepared to be thinking like the BEFORE you start your medications!! And yes, there are things other than poor adherence which can cause drug resistance. The situation to avoid is any circumstance in which the desired blood level of the drugs you are taking becomes low. This can happen for several reasons: 1) poor adherence (simply don't take the pills or take them off schedule so that for periods of time each day the levels of drug in the blood are low), 2) drug interactions - some drugs interfere with the metabolism or digestion of the antiretrovirals such that you could take every dose of a prescribed antiretroviral medication and still have a low level of drug in your blood stream based upon another drug you are taking. There is a long list of "other" drugs to be careful with (listed on the package insert of the antiretroviral drugs) and you and your physician should carefully review any other medications you are taking now (or start in the future) to make sure there are no significant interactions, 3) malabsorption - the antiretroviral drugs could be incompletely absorbed from your intestine - typically because you have a diarrheal illness which is causing almost everything you put in to rapid transit out the other end. Generally, this is not a long-lasting problem, nor severe enough to cause resistance, but something to think about in people with more chronic malabsorption problems, and finally 4) potency - it is possible to pick a good antiretroviral treatment regimen that is simply not strong enough for your particular virus. Clearly an issue in the case of drug resistance before starting treatment, but also an issue for people with relatively higher viral loads (i.e. >100,000 copies/ml). These are the other major reasons, though I still think that adherence issues are by far and away the most prevalent problems. Good luck.

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