Doesn't viral replication continue at some low level even if the patient is adherent on meds and is UD ? and if that's true doesn't it imply that resistance to the current med the patient is on is inevitable?

Thank you for posting these great questions.

It turns out that there is some evidence that virus persists in certain parts of the body even when viral load is undetectable in plasma. However, most of the data suggests that in most of these cases virus is not evolving to become resistant to the drugs. Consequently, while I can't say for sure that resistance will never develop in these situations, I do believe that for most people with undetectable viral load who are consistently taking their medication resistant virus will not emerge. Obviously only time will tell, but even if I am wrong it is likely to not occur for many years, at which time there will continue to be many treatment options.

Best, Eric