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HIV Drug ResistanceHIV Drug Resistance
           
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Newly diagnosed, doing well on meds
Sep 6, 2001

Dear Dr.

I am a 23 year old male in pretty good health. I was diagnosed last November, v.l. 40k and t-cells of 190. Ihad never received treatment for HIV before, and within 2 weeks I started a regimen of Kaletra, Epivir and Zerit. By the three month mark on treatment I was undetectable (less than 50) and my T-cells started to climb. I have remained undetectable and have seen an increase in my T-Cells. My main concern is resistance. I feel as if I am just waiting until I get my results and it is determined that I have developed resistance. What is the normal amount of time resistance takes to develop?? I know there are many factors involved, but I religiously take my meds (having missed only one dose in 1 year) and this seems to be my only anxiety.. Please advise

Christian

Response from Dr. Little

First of all, the major pathway to drug resistance is by missing doses of your antiretroviral medications - which you have not done. Drug resistance develops when the amount of drug in your blood stream in not sufficient to keep the HIV virus from replicating or reproducing. Once it starts to reproduce, the viral load becomes detectable and strains of virus that develop drug resistance mutations (a result of natural chance events within the viral lifecycle) are favored, or will reproduce more effectively than drug susceptible strains, until you have majority population of virus within the blood that is drug resistant (and will then be detected by the available drug resistance testing methods).

You are on a very potent regimen and are doing very well with an undetectable viral load. In fact, if you can maintain your excellent drug taking patterns, then there is no reason to think that you will ever develop drug resistance. It is a common misperception that drug resistance is an inevitable fate of those taking antiretroviral drugs. It is in fact, mostly preventable - by taking potent therapy as prescribed without missing doses. There are people who have been taking potent antiretroviral therapy for more than 5-6 years now who are still completely suppressed and doing well. You are on the right track - just stay there!


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