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HIV Drug ResistanceHIV Drug Resistance
          
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Very worried about resistance?
Jul 30, 2001

Hi doctor,

I have been on combivir/viracept since september 1999, viral load was iundetectable and T-cells were howering 200, in my last check up my VL results were 201 and my doctor had it done again a month later which came back at 625?, I am very compliant with my meds, I have missed 3 doses tops in this almost 2 years. Now my questions are, can resistance develop even in the presence of meds?, do I have any other options for treatment that can take me back to below 50?, please respond I am very worried about it.

Response from Dr. Little

I understand your concern - after such a prolonged period of complete suppression, the appearance of two detectable viral loads would also concern me. I also believe that there are more potent combinations of antiretrovirals around now than the regimen you are currently taking, so I think you have many options. My general approach would be to follow your viral load quite closely - once it is above 500-1000, you can have drug resistance testing performed. Alternatively, you could discuss with your doctor what other potent regimens might be available to you - you may still want to try and perform a drug resistance test now, because you might get a result which would help guide your next treatment choices and also indicate which of your current medications might still work (now or in the future).

Regarding your questions specifically - yes, the process of developing resistance is one that involves the presence of antiretroviral medications and continued viral replication - these two together give rise to resistance. There are many other treatment options which could take your viral load back down below 50


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