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HIV Drug ResistanceHIV Drug Resistance
          
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Are resistant viruses less damaging than wild type?
Jun 6, 2001

I have no treatments options left, is there is information on whether maintaing a resistant viral strain is less damanging than allow it to revert to the "wild type" virus

Response from Dr. Little

This is a very good question, but one for which we do not yet have a complete answer. In general, people who receive therapy do better (reduced risk of disease progression and death) than those who do not. This appears to be true even in people for whom we do not have a treatment regimen strong enough to reduce the viral load to undetectable levels. That is, if there are no better treatment choices, many physicians would continue a suboptimal regimen rather than stop therapy in hopes of reducing the risk of disease progression. My approach to this also includes an assessment of your CD4 cell count. That is, if your CD4 cell count is low (ie less than 100-200) then you are at a greater risk for HIV-associated infections than someone with a higher CD4 cell count. In this instance, I would more strongly favor continuing therapy even if complete viral suppression was not possible. However, if your CD4 was a bit higher (say above 300-400), then you have a bit more flexibility. In this case, some physicians might favor holding all therapy and thus reducing the risk of developing more drug resistance and watching the CD4 cell count closely. If your CD4 count drops, reconsider starting therapy. But, if your CD4 count stays relatively stable and above 200, then you may benefit by saving some of your partially effective treatment options available now to add to more potent treatment options that may be available down the road (soon we all hope!).

To more directly answer your question, there is not yet very good data to suggest that resistant virus is any less damaging than wild type virus. It may reproduce less well than the wild type, but many people with drug resistant virus maintain high viral loads and develop CD4 depletion, just as people with wild type virus do.


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