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HIV Drug ResistanceHIV Drug Resistance
           
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How quickly does resistance develop?
Nov 1, 2001

Dear Dr.:

My partner was hospitalized recently for three weeks with stomach and bowel problems. During the first two weeks, because he was having so many tests with NPO directives, he missed at least three, possibly four doses of his antivirals:kaletra, sustiva and ritonavir. After the second time, I raised my concerns to the dcotors and nurses but he missed one possibly two more. Finally, I demanded that, if they could not guarantee that my partner would receive his antivirals uninterruptedly, then he should not be taking them at all.

My question is do you think that missing these doses will cause hime to become resistant? I am outraged that he has been 99.9 compliant since 1996 but because of poor judgement by doctor and nurses, they may have jeopardized his regimen. He started this regimen in April and has been undetectable.

Please advise. Thanks!

Response from Dr. Little

Well, you are completely correct that it is better to miss all doses of your medications than to miss several here and there. Regarding the risk for developing resistance in the case of your partner - I would hope that if his viral load was less than 50 at the time he entered the hospital, then missing a few days worth may not constitute such a big risk. The way drug resistance occurs is by allowing continuous viral replication while subtherapeutic levels of drug are circulating. Since most people with viral loads of less than 50 may take from 3-7 days after treatment interruption to have enough viral replication to reach detectable levels, it is quite possible that this brief period of unintentional non-compliance may not be such a big deal. You are correct in your zeal to try and ensure that this does not happen again in the future - or that all drugs are stopped if one or more cannot be taken. I cannot tell you an exact likelihood that resistance developed in your partner's circumstances, but I can tell you that I think the risk is low. Hope this helps.


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