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HIV Drug ResistanceHIV Drug Resistance
           
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Drug Resistance
Dec 5, 2005

My question is that usually when people get infected with HIV, it usually take 5 or more years for them to hit full blown AIDS, well I have been infected for about 1 1/2 years, and about a month or so ago, I was already at full blown AIDS, I am not yet on any medication, my doctor wants to do one more blood draw, but since I hit AIDS so quick, and I am only 18, and I got infected at 17, if I have got a drug resistance or a "supervirus"?

Response from Dr. Sherer

Neither.

The average time from infection to an AIDS defining opportunistic infection, or a CD4 cell count < 200, is 10 years. However, about one quarter of patients have a more rapid disease progression, and an unfortunate 1-2% can develop AIDS within 1-2 years of infection. If you were really infected 1 1/2 years ago, then you fall within this category. It might be helpful to review the evidence that your infection occured then, as compared to earlier, as this is also a possible explanation for your rapid course.

We don't have any credible evidence that an HIV 'supervirus' exists. The more likely explanation for the above differences in the natural history of HIV is differences in individual immune responses to HIV infection.

There's also no reason to believe that drug resistance played any role in your disease progression, since you have not been on any treatment.

The virus usually pays a price - whether large or small - for developing drug resistance mutations in people on ART. For example, there is evidence that the common M184V resistance mutations impairs the ability of the virus to replicate. This evidence of a lower replication capacity with some mutations suggests that some resistant viruses have a lesser 'fitness'. There is some evidence that a lower replication capacity is associated with a lower risk of disease progression - not a higher risk, or evidence of faster disease progression.

I urge you to talk more to your doctor about this finding. He or she may have evidence, i.e. the result of a resistance test, that will show whether you have any resistance mutations. Your doctor can also plan the next steps with you; there are still reasons to believe that you can benefit fully from ART.


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