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Re: Resistance Problems
Sep 14, 2001

Thank you so much for your response to my earlier question. I was wondering if you could answer two more questions. In a treatment naive patient who has never before taken any HIV medications, who is not co-infected with hepatitis, who committs to taking medication as perscribed and who vists thier physican 3 to 4 times annually. Takes care of themselves with propper nutrition and excersicse, and who has resourses to take advantage of quality health care. What is in your professional opionion the likely hood that they would ever have a problem with the virus mutating such as to cause the medication to no longer keep the virus under control? My second question is do you agree that a person who does this should be able to live out the average life span in this country, inspite of HIV infection or would that be unrealistic in light of HIV infection?

Response from Dr. Little

To answer your first question, I think that if you put all of these factors together AND they result in a sustained viral load of less than 50 copies, it is very unlikely that resistance will develop. I don't think it is possible to say that resistance will never develop, because there are both things we do not yet fully understand (including the viral sequence that each person is originally infected with - which may carry measure of pre-existing drug resistance) as well as confounding factors which may influence the outcome. What I can say, is that this individual will have the best possible long term hope of avoiding drug resistance.

Regarding life expectancy, I don't think that anyone can answer this question. My hope is that HIV becomes more like a disease like diabetes - people live long and productive lives with diabetes, albeit with complications of the disease, but prolonged survival. I don't see any reason to predict that antiretroviral medications will fail after a certain period of time. If all of your question number 1 items are followed and the viral load stays less than 50, I think that it may be possible for our currently available medications to keep people suppressed for many years. I am also hopeful that we will have better medications to add or replace current meds as we go along.

This may seem like I am avoiding the questions, but I just don't think we have enough data to answer them with anything other than personal opinions. I have given you mine.


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