April 17, 2010

April 17, 2010
Resistance


Welcome to another day in my life. Today is Saturday and I hope your weekend is off to a safe and great start. Dab the AIDS Bear is in Honolulu, Hawaii for their AIDS Walk tomorrow. So Aloha to all our new friends!

I found out yesterday my ex, Gary, is in the hospital with kidney and other problems. I was sorry to hear he is doing badly and gave him a call to help cheer him up. Gary has not been able to eat solid food in almost a week. Hopefully, the docs will find the problem quickly and get him better soon. So here is a shout out to Gary! Feel better soon bud. Love and miss you. Big Bear Hug.

Today I would like to start talking about resistance

As has already been mentioned, one of the possible consequences of not taking your HIV treatment properly is that your HIV will develop resistance to anti-HIV drugs. This section of the booklet provides information on how resistance can develop; how to reduce the risk of resistance; cross resistance; resistance tests; and the transmission of resistant virus.

How does resistance develop?

HIV reproduces itself very quickly, making billions of new viruses every day. Because the virus often makes mistakes when copying itself, each new generation differs slightly from the one before. These tiny differences are called mutations.

Some mutations occur in the parts of HIV which are targeted by anti-HIV drugs. This can result in strains of HIV developing that are less easily controlled by the drugs. These HIV strains are called drug-resistant.

Drug resistant HIV strains vary Ė some may be highly resistant to anti-HIV drugs while others may be less so. When an anti-HIV drug is started, HIV that is fully susceptible to that drug disappears rapidly and drug-resistant viruses remain. If the HIV replication is not fully suppressed, these resistant viruses can continue to reproduce themselves despite the drug's presence.

Resistance is an important reason why HIV treatment can fail. Viral load, which should drop when you start a new drug combination, will increase again if drug resistant HIV is able to emerge.

Reducing the risk of resistance

* Take your HIV treatment - Taking your HIV treatment in the correct doses, at the right time, observing any food restrictions and avoiding interactions will reduce the risk of resistance developing.

* Take the right anti-HIV drugs - Before you start HIV treatment for the first time, or change treatment because your viral load is detectable, you should have a resistance test. There is more information on these tests later.

The results of a resistance test will help you and your doctor to choose the combination of drugs that is likely to be most effective against your HIV.

* Be honest - It is important to be honest with yourself and your doctor about the way you live your life. If it is probable or likely that you will not take your HIV treatment properly, then it is important that your doctor knows this. This will allow your doctor to prescribe a combination of anti-HIV drugs that has a lower risk of resistance. For example, HIV treatment that is based on a boosted protease inhibitor has a lower risk of resistance than treatment that is based on an NNRTI.

* An undetectable viral load - The aim of HIV treatment is an undetectable viral load. If you have an undetectable viral load, your HIV cannot become resistant to the anti-HIV drugs that you are taking. However, resistance can develop if your viral load becomes detectable and you continue to take anti-HIV drugs. You can find out more about viral load in NAMís booklet, CD4, Viral Load & Other Tests.

* Changing treatment - If your viral load is still detectable six months after starting HIV treatment, or falls to undetectable levels and then becomes detectable again in two consecutive tests, you should change HIV treatment.

Changing HIV treatment promptly can reduce the risk of drug resistance.

But before you change treatment, you should have a resistance test to help select the most effective combination of anti-HIV drugs. If you are changing HIV treatment because of resistance, it is very likely that you will need to start a new combination of drugs.

Some important new anti-HIV drugs have become available for people who have drug-resistant HIV. The NNRTI etravirine (Intelence) can work well in most people with resistance to the other NNRTIs. Another important drug is the boosted protease inhibitor darunavir (Prezista).

Important new classes of anti-HIV drugs have been developed. These include the integrase inhibitor raltegravir (Isentress), the CCR5 inhibitor maraviroc (Celsentri) and the fusion inhibitor T-20 (enfuvirtide, Fuzeon).

So help keep resistance from happening to you. More on resistance in my blog tomorrow.

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,





Daddy Dab