Treatment Naive vs. Treatment Experienced

Question

Hello. Thank you for the great site. I read it weekly.

I have a question(s), which I guess has a developing meaning for what HIV specialists are using today.

I have been pos for about 2 years and been taking viramune/truvada with undet VL and CD count always at 450 that long.

I understand that I am "treatment naive" at the beginning. When does a patient become treatment experienced and what does that mean exactly. Does that imply that treatment experienced are resistant to a class or specific drug, or just had a history of taking haart?

When would I become treatment experienced?

Why do some drugs that are once a day only prescribed for treatment naive patients (i.e. once a day kaletra trials) as opposed to treatment experienced (kaletra 2x a day).

Thanks again.

Answer

"Are you experienced?" - Jimi Hendrix, 1967

If you are taking HIV meds, you, my friend, are "experienced" and not "naive". These are problematic terms in that they can connote meanings not intended such as "resistant" or being "immature".

Trust me, it is not bad to be treatment experienced. You have a great CD4 cell count and an eviable viral load thanks to your experience with HIV meds.

As to why some meds are dosed differently depending on prior treatment history, it has to do with risk of resistance being present. Treatment experienced patients who are starting a new regimen often do so after virologic failure of a prior regimen. Resistance mutations acquired earlier can reduce the effectiveness of a subsequent regimen and also reduce the 'forgiveness' of a regimen for less than optimal adherence or when levels are low as is sometimes seen before a dose of some drugs dosed once a day.

In such cases, having consistently high levels of the drug is desirable.

DW