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HIV Drug ResistanceHIV Drug Resistance
          
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Finality?
Jan 4, 2008

When patients develop resistence to certain drugs, will they ALWAYS be resistent to them from that point on? I get the impression from a few sources that resistence is not always permanent. Sequencing and number of drug combination possibilities can make one believe that there will always be treatment options even when people become resisitent to multiple drugs. Please forgive my lack of knowledge if I am wrong- I just found out I'm positive and I'm scared of the possibility of one day running out of options. Your feedback is much appreciated. Thank You

Response from Dr. Sherer

Here are a few general truths about drug resistance and antiretroviral therapy (ART) to consider in answer to your questions: - drug resistance is always undesirable and best avoided if possible - the best way for a person with HIV to avoid drug resistance is to take all of their medications at the right dose and the right time - once resistance mutations are present, they are permanent and can recur at any time under the right drug pressure - drug resistance is not a black and white or all or none phenomenon, rather drug resistance includes 'grey' zones in which an individual's virus may be partially resistant to a certain drug - there are only a finite, limited number of effective ART regimen options for any individual living with HIV infection. For this reason, each new ART regimen, and especially the first regimen, represents a precious opportunity to fully suppress the virus and restore good health

Your question may be influenced by much recent good news on new ART drugs and regimens, including new classes of drugs (such as the integrase inhibitors (e.g. reltegravir) and the oral entry inhibitors (e.g. miraviroc)) and new forms of existing classes, such as the second generation NNRTIs (etravirine and rilpivirine) and newly approved third generation protease inhibitors (tipranivir and darunavir). These new drugs have increased the likelihood that a fully suppressive regimen can be found for individuals with heavy past treatment histories and multiple resistance mutations.

Unfortunately, even these fine new drugs and others to come in the pipeline will not remove the difficult reality of drug resistance. Drug resistance should be considered to be permament once it occurs, and to be 'unforgiving', in that the memory of past drug resistance, even if it is dormant and not shown on a recent resistance test, is still alive and well as archived resistance mutations that will recur in force if an attempt is made to use the same drug with which resistance developed previously.

Rather than being scared, you and your doctor can channel that energy of yours towards more productive activities like maintaining the best possible adherence to your medications that you can achieve.

HIV does not require you to lead a fearful life - far from it. Like diabetes, for example, HIV requires you to have a healthy respect for its demands, and an effective working knowledge of how the disease works, so that you can take care of yourself. You and every other person living with HIV can quite easily master this modest amount of information. The fear is just a waste of time, which is the one thing none of us have enough of.

Talk to your doctor about all of this, and figure out a plan together to get the most benefit from your drugs, prevent drug resistance, and let go of the fear.


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