Drug-Resistant HIV on Rise as Medicines Misused

Widespread misuse of HIV drugs has led to drug resistance in at least half the US population under treatment, scientists are reporting today. Contrary to forecasts made in 1996 when combination drug therapy was introduced, it is not the poor and IV drug users who have the highest rates of resistance because of failure to properly take the drugs. Rather, it is white, gay, fully insured, highly educated men who carry the most highly drug-resistant viruses.

A national survey of some 2,000 HIV patients, conducted by RAND Corp. and the University of California at San Diego (UCSD), found that 64 percent of patients are now getting less benefit from their drug cocktails than they were two or three years ago, as measured by rising levels of the virus in their blood. Among those with rising HIV blood levels, 78 percent have drug-resistant HIV. Even newly infected treatment-naive individuals are showing astonishing levels of drug resistance -- one out of five carry drug-resistant viruses.

This means that by the most conservative possible reckoning of the data, "half of the people under care in the United States right now have resistant virus. It's quite frightening," said senior researcher Dr. Doug Richman of UCSD. Richman will present the findings today at the annual Interscience Conference on Antibacterial Agents and Chemotherapy meeting in Chicago (www.icaac.org).

"What is not politically correct to say in public is that both providers and patients are using these drugs suboptimally," Richman said. Well-educated patients and their doctors closely follow reseach and trends in highly active antiretroviral therapy (HAART), changing treatment plans often in search of minimal side effects, ease of use and viral suppression. But each switch increases the likelihood of mutant, drug-resistant HIV.

Richman fears this continued pattern of chaotic use means "we'll end up recapitulating the antibiotic story," referring to antibiotic-resistant bacteria. Hastening the emergence of resistance, HIV mutates more rapidly than bacteria, and HAART must be taken for the rest of the patient's life. Because the size of the HIV-positive population in wealthy nations is small, "the incentive for the pharmaceutical industry to develop drugs against resistant HIV may not be there the way it is for antibiotics," Richman said.

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