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drug resistance - when does it occur?
Jul 10, 2007

Dear doctor, My husband is HIV positive.He is on Viraday and has an undetectable viral load. Just wanted to know, why does drug resistance develop? If he takes medicines regularly without skipping a single dose, will drug resistance still occur?

Thanks and Regards,

Response from Dr. Sherer

Your husband is giving himself the best possible chance to avoid resistance by taking his medications exactly as prescribed without fail.

Unfortunately, resistance can still occur in this setting, even if his adherence is perfect, though it is uncommon. The reasons for this are many. For example, more people in this era are acquiring a strain of HIV that already has one or more resistance mutations, and, if a resistance test is not done before starting ART, that fact may not be recognized, and a regimen might be chosen that would not be expected to be fully suppressive in the presence of that mutation. Or your husband may experience a drug interaction between his ART regimen and other medicines. For this reason, I advise patients never to take other medications without first checking with their doctor.

Still, the risk of resistance is very small when all doses of a suppressive regimen are taken as prescribed, and you and your husband are doing everything that you can do by ensuring that he takes each dose of his medication on time.

I urge you and your husband to talk to your doctor about your concerns and these observations.


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