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Drug resistance
Nov 2, 2010

I had a friend that was diagnosed HIV+ in 2003 at the age of 21 and it was estimated he had been infected for 3 years. He had an enlarged lymph node and night sweats, which led his Internal Med doctor to order an HIV test. He chose not to see an HIV specialist, but to stick with his Internal Med doc. CD counts and viral load tests were done and he was immediately put on meds.

Around 2008 he started feeling tired and wasn't taking his meds as he should and didn't visit his doc regularly. In 2009 he developed shingles and his doctor advised him how important it was to take his meds correctly. In Jan of 2010 he developed pneumonia which led to Acute Respiratory Stress Syndrome and I'm sorry to say it claimed his life.

My question is this, he was young and healthy for a while after his diagnosis. It seemed in the end he was giving up. Had he taken his meds like he should have, could this have been prevented? Also, does not taking the meds properly lead to drug resistance, and does this in turn lead to complications such as shingles and pneumonia? I'm just wondering if this could have been prevented. I'm also wondering if he had chosen to see an HIV specialist, would more precautions have been taken.

Thanks Dr Bob for all you do! I read your forum daily and have learned so much. You're truly an inspiration.

Response from Dr. Frascino

Hello,

Your friend's story is truly tragic. All HIV-positive folks should be treated by an HIV physician specialist if at all possible. Although without knowing more details about your friend's case, I cannot say for certain, I very strongly suspect that if he had been under the care of an HIV-knowledgable physician, he may well have had a dramatically different clinical course and might be alive and quite healthy today.

Responding to your specific questions:

1. If he had been adherent to an effective combination antiretroviral regimen, there is an excellent chance his HIV replication would have been turned off (viral load would decrease to undetectable levels) and his immune system would have rebounded somewhat (CD4 counts would have increased).

2. Non-adherence to antiretroviral therapy can lead to drug resistance. The development of drug resistance makes antiretroviral medications less or not effective, which in turn allows HIV to replicate wildly. When the HIV viral load increases, CD4 cells are attacked and destroyed and the person becomes progressively more immunodeficient (unable to fight off infections and cancers). Shingles, pneumonia and a host of other opportunistic infections can result. It's these opportunistic processes (infections and malignancies) that lead to the demise of HIV/AIDS patients. Perhaps your friend's sad story will serve as a cautionary tale for others who may not be taking their mediations as directed or who are not being monitored by an HIV physician specialist.

Dr. Bob



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