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HIV Drug ResistanceHIV Drug Resistance
           
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Drug resistance Q.
Sep 14, 2008

Hi,

Can colds, flu, pneumonia, or baterial infections a sign of drug resistance or can possibly lead to drug resistance?

Response from Dr. Sherer

Yes, intermittent infections could be a sign of drug resistance and an ineffective response to ART, though there are better ways for a patient and their doctor to tell whether or not ART is working, i.e. regular evaluations and testing of viral loads, CD4 cell counts, and, in the presence of viremia, drug resistance testing. In particular, recurrent bacterial pneumonia, viral infections such as herpes zoster infections or papilloma virus infections, and chronic or severe bacterial infections can be sign of a weakeded immune system, and some meet the definition of clinical AIDS. Recall that the clincal definition of HIV treatment failure is the ocurrence of a new AIDS defining opportunistic infection, or new severe HIV-related infections or symptoms.

And yes, intermittent infections can be a factor in the development of drug resistance. Anything that stimulates the immune and inflammatory response is known to be associated with a transient increase in viral load, which could potentially increase the risk of virologic failure and the development of drug resistance.

These answers in the abstract do not do justice to the complexity of the proper answer to your question, and I urge you to talk to your doctor about your particular situation and the colds, flus, pneumonia, and bacterial infections that you have in mind.

I say this because common colds, upper respiratory infections, viral gastroenteritis, and minor bacterial infections are common in the general population, including people living with HIV who are on ART or who have yet to be treated, and their presence may not signify EITHER the presence of drug resistance or any increased likelihood of the development of resistance.

So rather than worrying about a single cold or flu, multiple episodes of colds, recurrent bacterial infections (eg staph furuncles), I urge you to talk to your doctor about these episodes and what they mean for you, taking into consideration the whole patient history, initial and current CD4 cell count, ART treatment history, etc.


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