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HIV Drug ResistanceHIV Drug Resistance
           
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Too good to be true?
Apr 5, 2001

I'm one of the lucky ones.

After not tolerating PI's well, but sticking it out for 4 months, I reached undetectable viral load (yea!)

My doctor then switched my Ritonavir and Indinavir to Sustiva, and left me on 3TC and d4T. Life is great.

Viral load still undetectable, CD4's continually increasing (currently just below 1000 - that's another milestone I'm hoping to hit), no side effects, simple schedule (3 pills 2x/day) with no dietary restrictions.

I've never missed a single dose of my meds since I started HAART. But I'm waiting for the other shoe to drop. This seems too good to be true.

Based on what we know thus far, if I stay compliant, could I really stay on the regimen indefinately? Do we think resistance creeps in regardless of compliance, or does it just happen faster with non-compliant people?

I suppose meds will eventually get easier (once daily dosing with no side affects, new drugs, etc), so things may even get better, but I would go off HAART altogether before I go back on a PI based regimen.

Response from Dr. Little

Congratulations. The good news is that we have no reason to believe that people with superb adherence and undetectable viral loads are destined ever to fail their antiretroviral regimen. It is clear that drug resistance does occur in people who do not have complete suppression of their viral replication, but there may be a threshold below which resistance is very unlikely to develop. Although I do not believe that we know precisely what this threshold level is at present, it is probably below 200 copies/ml. It sounds like you should do very well for quite a while. I would also hope that with even simpler therapies in the future, things may get even easier for you. Keep up the good work.


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