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Author Topic: Drug Resistance  (Read 2405 times)

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Offline OutOfDarkness

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  • Posts: 90
Drug Resistance
« on: June 13, 2008, 06:29:35 PM »
Has anyone heard of becoming resistant to treatment if you start and stop meds and if you switch around too often? 
« Last Edit: June 13, 2008, 06:51:35 PM by OutOfDarkness »
2000 - seroconverted
2005 - cd4 350, VL 113,000
3/06 - started sustiva/truvada
3/08 - cd4 1,300 VL >50(undet.)

Offline newt

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  • Posts: 3,887
  • the one and original newt
Re: Drug Resistance
« Reply #1 on: June 13, 2008, 07:02:24 PM »
Yes and no...

On start-stop, with NNRTIs (Sustiva etc) the drugs have such a long half-life that stopping these outright means the drug hangs around at a level low enough for the virus to adapt.

On changing, no, provided your viral load is undetectable and no prior mutations. 

PIs less susceptible to resistance from stop-start (indeed flakiness/variations generally).

- matt

Now playing: cat feet padding on hardboard sub-floor
"The object is to be a well patient, not a good patient"

Offline OutOfDarkness

  • Member
  • Posts: 90
Re: Drug Resistance
« Reply #2 on: June 13, 2008, 07:14:00 PM »
Hi matt, thanks for getting back to me, what do you mean by mutations?
2000 - seroconverted
2005 - cd4 350, VL 113,000
3/06 - started sustiva/truvada
3/08 - cd4 1,300 VL >50(undet.)

Offline newt

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  • Posts: 3,887
  • the one and original newt
Re: Drug Resistance
« Reply #3 on: June 14, 2008, 11:15:24 AM »
A mutation is when the HIV virus changes its shape.

Every time HIV copies itself it makes mistakes. These mistakes usually mean one of its amino acid building blocks (called a codon) ends in a different chemical to the one expected.

Many HIV drugs work by interfering with the chemicals at the end of particular HIV codons, or the bits of your cells which HIV attaches to using these chemicals (think Lego).

Therefore these changes in shape allow HIV to evade the drugs ie create resistance.

Not all mutations lead to resistance, though. Most just lead to plain broke versions of the virus.

Low levels of anti-HIV drugs (eg from not so good adherence, stopping and starting therapy) create an environment which favours evolution of mutations that cause resistance (think sunshine and tanning).

- matt
"The object is to be a well patient, not a good patient"

Offline OutOfDarkness

  • Member
  • Posts: 90
Re: Drug Resistance
« Reply #4 on: June 14, 2008, 09:45:50 PM »
ok, that's what I thought they were, but was unsure and thank you for explaining it to me.  I have another question that you might know the answer to:  I can get resistance testing which I understand, but can you be resistant to a drug even if you never took it before?  And if so why is this?  Is it because the virus I have was transferred to me from someone who was already taking the medication that I am resistant to?
2000 - seroconverted
2005 - cd4 350, VL 113,000
3/06 - started sustiva/truvada
3/08 - cd4 1,300 VL >50(undet.)

Offline newt

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  • Posts: 3,887
  • the one and original newt
Re: Drug Resistance
« Reply #5 on: June 15, 2008, 07:16:17 AM »
Yes you can start off with a type of HIV is resistant to drugs. This is a common, perhaps the most common, cause of resistance.

- matt

Now playing: Boogie Tonight, Tommy V vs Keller remix
"The object is to be a well patient, not a good patient"

Offline OutOfDarkness

  • Member
  • Posts: 90
Re: Drug Resistance
« Reply #6 on: June 26, 2008, 08:17:19 PM »
Hello Mat :)

I was just looking at may last post on this and have another question.   ::)  Have you ever heard if there is a reason why there are certain hiv strains that are resistant to certain drugs?  I have had a feeling that the reason for this is because the strains that are resistant are strains being passed to the receiver that have been treated with an hiv med.  In other words, the person who gives the virus and has been on meds passes that "treated" virus to someone who turns out to be resistant to the same meds the giver has taken.  Does this make sense?  It is just an idea that popped into my head and I never actually asked a doctor about it.
 
Hope your doing well!
2000 - seroconverted
2005 - cd4 350, VL 113,000
3/06 - started sustiva/truvada
3/08 - cd4 1,300 VL >50(undet.)

Offline newt

  • Member
  • Posts: 3,887
  • the one and original newt
Re: Drug Resistance
« Reply #7 on: June 27, 2008, 03:47:06 AM »
HIV is a recombinant virus, that is to say, it mixes itself up when it reproduces.  It is possible to get a type of HIV that is a mix of two other strains.

Very, very, very occasionally, this mixing leads to genetic changes that mean a  strain of HIV is naturally resistant to one or more HIV drugs.

But, you are right, the main reason for a strain of HIV having a resistance-causing mutation is that at some point someone on treatment was taking combination therapy while his/her viral load was unsuppressed, which allowed resistance to develop.

This is the evolutionary starting point. Many people have acquired HIV with a resistance-producing mutation and passed it on without taking treatment (eg in the early part of infection before they knew they were HIV-positive).

An HIV infection is really a mix of types, and there's no reason why resistant types can't be transmitted along with "wild" types. People generally have a bundle of types of HIV, not just 1.

You have to remember that early on in treatment the approach used (just 1 or 2 drugs) was not brilliant at getting viral load below 50 copies, the side effects horrible, treatment breaks more common, adherence harder  and the evolution of resistance eg from stopping NNRTIs not well understood, which created the backdrop for resistant mutations to establish themselves.

- matt
"The object is to be a well patient, not a good patient"

Offline OutOfDarkness

  • Member
  • Posts: 90
Re: Drug Resistance
« Reply #8 on: June 27, 2008, 08:23:06 PM »
Hello Matt,

Thanks for the info.  If you don't mind me asking, are you in the medical field or are you self-taught, because getting a good understanding a lot of what goes on with this disease needs to be researched on our own or with our own questions to our docs.  You seem to have a good understanding of a lot of this, so just wondering :) 
2000 - seroconverted
2005 - cd4 350, VL 113,000
3/06 - started sustiva/truvada
3/08 - cd4 1,300 VL >50(undet.)

Offline newt

  • Member
  • Posts: 3,887
  • the one and original newt
Re: Drug Resistance
« Reply #9 on: June 28, 2008, 04:41:47 AM »
I learnt to save my own life and life of my friends. So I am self-taught. Like many treatment activists/educators I discovered I have a knack for reading science, it was not something I set out do do when I was 5 (though my mother did want me to be a doctor but I wanted to be an artist like my dad).

A basic primer on HIV and treatment designed for people with no previous experience:

Treatment training for advocates

Field tested and written at the grass roots - sections 1-4 is the core

All the rest, more advanced:

HIV Medicine textbook PDf

The AIDSMEDS lessons are a good read too.

- matt
"The object is to be a well patient, not a good patient"

 


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