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HIV Drug ResistanceHIV Drug Resistance
           
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A question of resistance?
Nov 29, 2001

Hello, firstly, I would like to thank everyone for their helpful advice on "The Body" web site. I am a 49 year old male, in good physical condition, 185 pounds, 5 ft. 9 inches, I lift weights, don't smoke, don't drink, don't take drugs, I do try to eat propertly but also struggle with depression and suffer from insomnia. I have provided info. about myself in an effort to give you a general picture of my current health status which I can appreciate may have some bearing on the progression of the HIV infection. I try to excercise regularly but not as often as I would like due to fatigue from time to time. I have been positive for approx. one year, am currently taking combivir and sustiva. My last tests indicated that my vl is undetectable and my CD4 count was at 814. I know that this is quite good, but it does not prevent continuous worry about becoming resistant which may account for some of my depression. I would like your opinion please, that if I continue to be totally compliant in taking my medications, what are the chances of becoming resistant over time. What factors could contribute to resistance besides non-compliance with the current drug therapy? I appreciate that you do not have a "crystal ball" but your opinion on strict compliance on my current drug therapy would be greatly appreciated and would give me some peace of mind. I am scheduled to have a new round of tests completed early in December but still worry. Thank you for your response.

"Positive in Canada"

Response from Dr. Little

It does sound like you have done extremely well with your treatment adherence and lifestyle choices. The factors that contribute to drug resistance are really any factors which lower the blood levels of the drugs you are taking (non-compliance, severe vomiting or diarrhea, improper storage of refrigerated medications, drug interactions with other often non-HIV drugs) in the presence of a detectable viral load. The most common cause of drug resistance, I suspect, is non-compliance, but there are clearly other reasons that people develop drug resistance. The good news is that we do not "expect" drug resistance at any given time after treatment has been administered - in other words - the drugs are not expected to fail after some prescribed period of time. At this point I know of no data to suggest that a potent combination treatment regimen should not work indefinitely if compliance is nearly 100% and there are no other causes listed above in play. I should mention that it is also possible to acquire drug resistance from the person who transmitted the virus to you (if this person had drug resistance), but this is more difficult to determine and should be managed simply with close and standard follow-up. Keep up the good work - it sounds like you are doing everything right!


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