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HIV Drug ResistanceHIV Drug Resistance
           
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Resistence for 20 years?
Sep 6, 2002

Hi and thanks for answering this. I have been on my first regimen of epivir, ziagen and sustiva now for 26 months. My adherence is excellent and have been undetectable since starting treatment. Are my chances of remaining undetectable greater as time goes by? Although my viral load is low I cant seem to raise my T-cells above 300. Is this a factor in long-term resistence? Also I recently read of a study done on naive patients that started treatment with triple-drug therapy only and after following them for 4 years it was concluded that drug resistence could be possible for as long as 20 years. Have you heard of this study and do you agree?

Response from Dr. Little

There are several factors which could influence your slow to rise T cell count (i.e. higher age, other medications, permanent HIV damage). Depending upon how low your T cells were when you started therapy and how old you are, you may not see the rapid and high rise in CD4 that you would like despite having completely suppressed your virus. I would look closely at your CD4 percentage as well and ask your physician to discuss with you whether you are actually still making slow progress (which is good), or things have taken a turn for the worse. The rate of CD4 recovery is fastest in the first few years and then does slow down significantly. Regarding the risk of resistance - my opinion is that as long as the necessary circumstances for the development of drug resistance are avoided (low blood levels of antiretroviral drugs AND detectable viral load - typically greater than 500 copies), you are not at a great risk of developing drug resistance. Having said this, if you take your current regimen for 20 years and have a few periods of lower than target blood levels of antiretroviral drugs, then it is POSSIBLE (not necessarily probable) that you could develop drug resistance during these times. Unfortunately, the best we can suggest is to maintain rigorous adherence while taking antiretroviral drugs and to always start and stop medications under a doctor's supervision to minimize the risk of developing drug resistance. Finally, if you still want to do something to really maximize the chances that you can improve your CD4 cell count, you could talk to your doctor about intensifying your treatment regimen. I do not routinely advise this, but it is something to consider in certain circumstances. Good luck.


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