Feb 21, 2004
When we are looking at the present drugs approved,do u as doctors forsee any failures on treatment in two decades to come,based on your experiences with your patients?
Worried South African
Response from Dr. Sherer
Unfortunately, our experiecnce suggests that only 50-70% of patients have the best outcomes of ART after 1-2 years, and resistance is common among patients with treatment failure.
Our best outcomes suggest that with a first positive response to ART, i.e. rising t cells and viral load below detection, these good results can be sustained for as long as 5+ years.
Noone knows how long these best results can last, so we all share your worries as we look ahead two decades.
Note that even when resistance occurs, some second line regimens have achieved success also in 50-70% of patients, with good results for as long as 2-3 years.
Finally, as you suggest, in general the growing problem of resistance is a threat to our response to HIV, and there is evidence that it is being increasingly transmitted, with adverse effects on the response to treatment for the person who acquires it. It is a worry we all share.
In South Africa and anywhere pregnant women have been treated with single dose nevirapine to prevent transmission to the baby, there is another resistance worry, i.e. 20-60% of these women develop resistance to nevirapine following exposure to a single dose.
The best way to protect the baby AND to provide effective treatment for the mother is to treat the pregnant woman with 3 drug HAART, in which case drug resistance is much less commonly reported. Unfortunately, that is not possible now, and may not be possible in many regions for many years, so single dose NVP will continue to be used to prevent mother to child transmission.
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