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HIV Drug ResistanceHIV Drug Resistance
           
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resistance built up too soon
Dec 6, 2004

I had discovered that I was HIV positive last year when I developed karposis sarcoma,for the past two years ago that spread to my internal organs, stomach, lung, anal area, as well as my neck,arms, front and back torso and face. I also had PCP, MAC in some lymph nodes and bone marrow, CMV, and candidiasis. It hit me all at once so the doctors hospitalized me last year, found i was hiv + with a cd count of 5 cd-4 cells with a viral load of 3000. I have been only with one live in lover for the past 10 years, and had practiced safe sex with him since the day we met 10 years ago, since I did not know my hiv status for that 10 year period, with my current partner. Before my current partner I had a previous live-in lover for 3 years and we did not practice safe sex back then in the late 1980's I am a top and he was a bottom. I thought we were monogomous only to discover he was not,when I found out my first boyfriend of 3 years was sleeping with a drug addict as well as with many other people on the side, and was a bottom and was unsafe with these other people, I was fearful that I might have been exposed to hiv and was afraid to get tested. I assume that my fist lover from the 3 year period may have been positive, to this day i don't know if he was or not, but decided to play it safe from then on, so I always used a latex condom with my next partner for 10 years, that partner is a bottom with me and remains hiv negative to this day. I was healthy for that 10 year period of safesex with him. When I got sick and lost 30 lbs in 3 months last year and my doctors found I was hiv+ as well as having the KS and other oportunistic bugs I was hospitalized and the doctors gave me chemo last year, and that completly cleared up the KS lesions externally as well as internally. I was put on Hart cocktails and then my cd count went up to 80 and my viral load went down to to 1200 As of now all those other oportunistic bugs are not expressing themselves as they were last year. I was told I was a "slow progressor" since remaided safe for tens plus years and was healthy for that 10 year period and was positive during that period, I did not know this until last year when I almost died from the many opportunistic bugs that hit me all at once. With chemo and the cocktail therapy I have no more KS in side or out and no more of PCP, MAC nor CMV that is not expressed as it was last year. So my viral load was down to 1200 and cd-4 was up to 80 6 months ago. Now I seem to have developed resistance to Sustiva and Viread and my cd-4 count dropped down to 20 with a big jump of hiv viral load to 300,000!!! My infectous desease Dr, found I developed resistance to the two named anti viral drugs, so fast within a 6 month period, I took the antiviral drugs consistantly and always never missing any doses, i am with my only partner who is a bottom and we are always safe, I had not gone outside our relationship, therefore never exposed to anyresistant hiv, the only way that I could have been exposed to a hiv that is resitant to these antiviral drugs was that I received up to 7 bags of blood (I was anemic in the past year due to azt components of by first cocktails and these 7 bags were given in me spread over the past year. I remain healthy even though my cd-4 count is at 20 with that giant rise of 300,000 viral load (from 1200 six months ago), Can you tell me what is going on? I had been swithed from Sustiva and viread to kaletra and trizivir since late sept. of year 2004 Now I just got a blood test on 11-23-2004 and will find out what my cd-4 and viral load is. How did I seem to do so well six months ago and then suddenly jump to 300000 viral load and drop from 80 to 20 cd-4 in such a short period and why develop a resistance to viread and sustiva while being on them with a third anti viral drug called emtriva which i did not develop a resistance to in such a short time?. I remain healthy with no more opportunistic infections like a year ago. Can you tell me what is going on here???? Since my experienced ( since 1982)Infect. Desease. MD can only tell me that I developed resistance to the 2 drugs for unknown reasons, can you tell me why I

Thank you for your time.

Response from Dr. Sherer

The speed with which resistance develops varies by drug class and by individual agent. People who are treated at later stages, when their CD4 cells are below 100 and their viral loads are above 100,000 are at greater risk of regimen failure and rapid development of resistance.

In your case, your first regimen - FTC (Emtriva), TDF (Viread), and EFV (Sustiva) - has had very good results, even in people with advanced disease with success rates over two years of 75%. However, because two of the drugs have only single amino acid mutation changes that confer full resistance (FTC and EFV), when resistance occurs, it can occur rapidly and involve multiple classes of drugs, as happened in your case.

It may be that you had a lapse in your adherence which allowed for resistance to occur. It may also be that you received some ART in the past for a short period of time, and had one or more pre-existing resistance mutation. Or it may be that you acquired a virus years ago from an ART-experienced person, and that virus had some resistance mutations. Or it may be that even though your adherence was perfect or near-perfect, the virus was able to gain the upper hand for other reasons. As your doctor suggests, we are not always able to identify a specific reason that a good regimen such as yours fails in an individual case.

For your part, you can do your best to stay adherent to the next regimen, and hope that the possibility of complete viral control is still available to you, as it should be for one starting their second regimen. I urge you to take these issues and questions to your regular doctor.


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