Quantcast

Subscribe to:
POZ magazine
E-newsletters
Join POZ: Facebook MySpace Twitter Pinterest
Tumblr Google+ Flickr MySpace
POZ Personals
Sign In / Join
Username:
Password:
Welcome, Guest. Please login or register.
August 28, 2014, 07:17:43 PM

Login with username, password and session length


Members
Stats
  • Total Posts: 636484
  • Total Topics: 48310
  • Online Today: 258
  • Online Ever: 585
  • (January 07, 2014, 02:31:47 PM)
Users Online

Welcome


Welcome to the POZ/AIDSmeds Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and others concerned about HIV/AIDS.  Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the conversation yourself by registering on the left side of this page.

Privacy Warning:  Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

  • The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own physician.

  • All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

  • Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators of these forums. Click here for “Am I Infected?” posting guidelines. Click here for posting guidelines pertaining to all other POZ/AIDSmeds community forums.

  • We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are true and correct to their knowledge.

  • Product advertisement—including links; banners; editorial content; and clinical trial, study or survey participation—is strictly prohibited by forums members unless permission has been secured from POZ.

To change forums navigation language settings, click here (members only), Register now

Para cambiar sus preferencias de los foros en español, haz clic aquí (sólo miembros), Regístrate ahora

Finished Reading This? You can collapse this or any other box on this page by clicking the symbol in each box.

Author Topic: Can Resistance Still Occur Even With 100% Adherence?  (Read 23463 times)

0 Members and 1 Guest are viewing this topic.

Offline Londonguy

  • Member
  • Posts: 104
Can Resistance Still Occur Even With 100% Adherence?
« on: June 06, 2006, 09:30:06 AM »
I've read quite a lot about resistance and I'm not completely sure I understand it.

From what I've read, it seems like it works in a similar way to evolution/natural selection.  That is to say that a mutation during the process of reproduction may lead to a variant of the virus that enables it to survive in conditions that the other forms of the virus can not.  Hiv meds practically stop, or at least drastically slow down, the reproduction of the virus, thus limiting the amount of mutations that can conceivably occur.  Have I got this bit right?

However does this not mean that, even with dramatically reduced reproduction, there is still the possibility of a mutation occuring, rendering it resistant to the meds you are currently taking, even if you take the meds every single day.

I find it a little discouraging to think that I could still get resistance even with total adherence.

Offline Moffie65

  • Member
  • Posts: 1,755
  • Living POZ since 1983
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #1 on: June 06, 2006, 09:37:09 AM »
.................................. there is still the possibility of a mutation occuring, rendering it resistant to the meds you are currently taking, even if you take the meds every single day.

I find it a little discouraging to think that I could still get resistance even with total adherence.

Reality bites, doesn't it?

Yes, is the answer you are going to get from me.  I have been on meds since 1994, and my virus has mutated through most of the medications.  I am not totally out of options, but here we are in June of '06, and my virus is again mutating after five full years of stability.  My adherence has been in the 99% range for all of the past 12 years, but the way this virus works, there is little hope that we will be able to STOP the virus mutations in the near term.  I am hopeful that the drug companies will continue to work towards a cure, but hell, at 59; and having lived with this bug since 1983, I am very happy with the fact that I am still here, still stirring the pot, and trying to make a difference in this world.

Here's to coctails.

In Love and Support.
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline ademas

  • Member
  • Posts: 1,151
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #2 on: June 06, 2006, 09:43:08 AM »
Good question, LG.

This past week I've read a few things that sort of threw me for a loop.  The PBS Frontline report states that resistance can occur in as little as 3-5 years, and the quiz on their website says that the meds extend life for an average of eight years.  (Since I just started year 12 on the meds, I found this news a little depressing.)  Then you read on, and they seem to be talking about developing countries, where oftentimes only a few of the cocktail combinations are available.

I'll be watching this thread, because the more I read, the more I don't know what to think.

Offline jack

  • Member
  • Posts: 1,578
  • fomerly the loser known as Jake
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #3 on: June 06, 2006, 09:59:02 AM »
I have alway adhered to my drug regimen since I started in 89. I have been undectable only once, about three months ago,but I am resistant to those drugs now. I rarely have a regimen last longer than 1 year. Usually in about 6 months they are history. Everyone is different.

Offline Londonguy

  • Member
  • Posts: 104
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #4 on: June 06, 2006, 10:41:36 AM »
So it seems like meds, by their nature of slowing down reproduction, also reduce the risk of mutations occuring, but it's still eminently possible.  A little discouraging but I guess I have to think positive and look at the better odds with meds than without.

Can I ask Jack, if your regimens have generally lasted so shortly, what options are available to you at the moment?  It sounds like you would burn through most of the tablets if they last at most a year.

Offline HIVworker

  • Member
  • Posts: 918
  • HIV researcher
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #5 on: June 06, 2006, 11:14:13 AM »
Your analysis of resistance is pretty much right. That's the problem with current HIV therapy. The response to the problem is two fold. Firstly there is a need to come up with new medications that are reactive against current resistance strains. This is a short-term solution but a do-able one. However, that way of treating HIV is like that carnival game where the mole pops up it's head and you smash it with a mallet. It's not a viable way to cure the disease. So everyone is working on better stratagies. One method is to try and find where HIV is replicating when people are on HAART and design things to hit it there. The final solution would be some sort of treatment that can stimulate the immune system to take over from current drug therapies and keep patients off medication for years.

R
NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

Offline Cliff

  • Member
  • Posts: 2,645
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #6 on: June 06, 2006, 11:25:15 AM »
As I understand it, since the meds are unable to reach every single organ/area in your body, HIV can and does replicate, (albeit probably very minimally), in certain parts of your body where drug levels aren't high enough to completely stop viral replication (for example your prostate or sometimes the brain/central nervous system).  As those viruses, (replicating in small numbers in certain organs), start to collect mutations, they can eventually create a mutated virus capable of replicating despite the presence of your drugs.  That mutated virus is then free to roam outside of the reservoir that created it and replicate elsewhere, (i.e., you are no longer undetectable).  Though when and how often that happens is probably unknown (or rather, not something you can estimate since it varies from person to person/infection to infection). 

You can't control that aspect of HIV.  But you can focus on reducing the chances of resistance occurring because of skipped dosages, (which probably happens much, much more frequently and is a much easier option for the virus to gain resistance).  Take your meds on-time, everyday, then you have done your part.  And that's all you can do.

- Cliff

Offline DCGuy511

  • Member
  • Posts: 61
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #7 on: June 06, 2006, 12:26:34 PM »
I have what may be a dumb question. Regarding the areas of the body where HIV can hide during HAART, is it nor possible to inject some sort of anti-retroviral med into those areas?  Granted, I'd be more comfortable with an injection into my prostate than one into my brain,  and maybe we'd have to have a whole different type of drug.  I'm just curious.

Anyone know where else the virus is likely to hide?

S
Steve
Infected/Diagnosed Fall 2003
"No Man Is An Island" - J Donne

Offline ademas

  • Member
  • Posts: 1,151
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #8 on: June 06, 2006, 12:31:35 PM »
lymph nodes.

Offline Cliff

  • Member
  • Posts: 2,645
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #9 on: June 06, 2006, 12:54:16 PM »
I have what may be a dumb question. Regarding the areas of the body where HIV can hide during HAART, is it nor possible to inject some sort of anti-retroviral med into those areas?  Granted, I'd be more comfortable with an injection into my prostate than one into my brain,  and maybe we'd have to have a whole different type of drug.  I'm just curious.

Anyone know where else the virus is likely to hide?

S
I dunno....never thought about that one.  Though there would probably need to be a cost/benefit analysis.  It still wouldn't clear HIV infection (since that's due to latent cells).  It may just result in lower resistance (in terms of resistance created despite complete adherence to oral meds)...but that may not be that significant enough to worry about. 

Plus you would likely have to do the injection in multiple places on a daily basis.  Daily injections into your brain/central nervous system, doesn't sound very pleasing (nor safe for that matter).  I reserve judgment on the prostate one.  Perhaps that might have its benefits.   ;D

Offline HIVworker

  • Member
  • Posts: 918
  • HIV researcher
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #10 on: June 06, 2006, 01:18:42 PM »
Cliff's analysis is very wise here. Injecting anything daily is a bad idea - just ask anyone who takes Fuzeon. It's not a viable therapy and the benefits of doing it might be outweigh the cost to the patient in terms of comfort and money (injections are more expensive). The other thing is really we don't know where HIV is hiding - there are a few good ideas - but it's hard to measure. This is indeed a focus of much research. One obvious place is the CNS/brain, as it has been hard to get all the medication there because of the blood/brain barrier. Another thing to think about is that not all cells take up the drug to the same amounts (here I am not talking about within a population of CD4+ lymphocytes but other cells that can be infected by HIV or take up the virus like DC's). Drug coverage in these areas is another area that needs to be looked at that could improve the resistance profile of many existing drugs. Again, these are all short term measures to improve existing therapy, but ultimately the key lies in getting people off therapy. I can't stress how important a goal that is and how hard we must work to achieve it. In the mean time, the above measures should help improve the lives of those who have to take HAART while we figure out what to do.

R

PS. Cliff, I am taking a lunch break right now, so I'm not stopping working just to be on this forum.
NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

Offline sdcabincrew74

  • Member
  • Posts: 540
    • My Manhunt account
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #11 on: June 06, 2006, 01:59:18 PM »
I asked my HIV specialist and my ID specialist this exact same question.  Both of their answers pretty much said this -- in 90-95% of cases, resistance is caused due to non-adherance to the med schedule.  The rest of the time it just happens naturally.  Although my HIV specialist stated he felt that it was probably closer to 98% of the time mutation occurs due to lack of adherance.

I take my meds as scheduled, ALWAYS.  I follow the rules of no antacids (reyataz does not like them) and I take them with a meal or snack.  It is a burden at times but I am not giving this sh1tty virus even one chance at mutating since I am already resistant to the class of drugs that include Sustiva.

So, after one year I am undetectable (and have been for six months) and hope to stay that way.
The difference between an overnight and a layover is luck!

Offline Londonguy

  • Member
  • Posts: 104
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #12 on: June 06, 2006, 02:21:38 PM »
So when people are diagnosed with resistance prior to starting meds, is that usually because of the person who infected them already having the resistance?

I may be barking up the wrong tree here, but if someone goes years before they start meds, does that not increase the chance that they will develop a resistant form of the virus before they have even taken a pill? 

I feel like I'm back in Science class lol  ???

Offline sdcabincrew74

  • Member
  • Posts: 540
    • My Manhunt account
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #13 on: June 06, 2006, 05:11:50 PM »
So when people are diagnosed with resistance prior to starting meds, is that usually because of the person who infected them already having the resistance?

I may be barking up the wrong tree here, but if someone goes years before they start meds, does that not increase the chance that they will develop a resistant form of the virus before they have even taken a pill? 

I feel like I'm back in Science class lol  ???

yes, according to my doc, I was infected by someone who was already resistant.  my doc said about 10% of new infections in my county are this way.  as for the second part of your questions I am not sure that is how it works, but I am just a flight attendant not a doctor.
The difference between an overnight and a layover is luck!

Offline newt

  • Member
  • Posts: 3,878
  • the one and original newt
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #14 on: June 06, 2006, 05:43:38 PM »
Resistance comes in two ways...

(1) It's there already.
(2) It evolves because the drugs do not assert enough presure to keep your HIV infection under control, and it learns to adapt.

An HIV infection is a mix of different strains of HIV, some "fitter" than others.  One (or a few) tend to dominate.  This mix may include a strain with a mutation that makes a particular drug less effective against it.  This means that an otherwise weedy, hidden strain can emerge when you start treatment cos the drugs have hammered the rest, but it has escaped extermination. 

Another reason for resistance developing is not taking the drugs on time and all the time.  This lets the virus(es), er, learn to adapt to the drugs and bud off new HIVs that aren't affected by them (or perhaps not affected as much).  In time, if you stay on the same drugs, these will come to dominate and your viral load shoot up... (this is called "viral breakthrough").

However, resistance is not inevitable... and not always important...

If your viral load is less than 50 copies (undetectable) the chances of a resistant strain emerging are very low. 

If your combo gets you viral load undetectable and keeps it there, then you can use the same drugs for many years, potentially indefinitely.

If you are just starting treatment this is a realistic goal.

The i-Base Introduction to Combination Therapy, UK + HIV-positive written, has a good n simple page on resistance.

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

Offline cubbybear

  • Member
  • Posts: 510
  • Joined August 2005.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #15 on: June 06, 2006, 06:58:55 PM »
Thanks for the confidence boost Matt, you just managed to settle my anxiety levels that were rising.
There's a bear in there!
Positive since 2000
Diagnosed 17/9/2005 CD4 35 VL 293,000
Meds 23/9/2005 Sustiva/Truvada
Currently CD4 232 VL Undetectable

Offline blondbeauty

  • Member
  • Posts: 1,784
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #16 on: June 06, 2006, 07:02:17 PM »
Acording to my Dr. resistance should not occur with a 100% adherence. A friend of mine who has been positive for 12 years has always been undetectable. This is his 10th year being undetectable. He has switched meds due to side effects but never for resistance issues. Anyway he is very responsible and just started studying to become a nurse.
The only member in these forums approved by WINBA: World International Nail and Beauty Association.
Epstein Barr +; CMV +; Toxoplasmosis +; HIV-1 +.
Counts when starting treatment:
V.L.:80.200 copies. CD4: 25%=503
Started Sustiva-Truvada 14/August/2006
Last V.L.count (Oct 2013): Undetectable
Last CD4 count (OCT 2013): 52%= 933

Offline J.R.E.

  • Member
  • Posts: 7,126
  • Joined Dec-2003 Living positive, since 1985.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #17 on: June 06, 2006, 07:08:06 PM »
Hello ,

You also need to take into account, what the long term effects these meds have on your organs...Liver, Pancreas... Not everyone can take all the meds that are available, even if you are not resistant to them, they simply can not be tolerated. vThe only hope is additional research for safer medications.


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

Offline blondbeauty

  • Member
  • Posts: 1,784
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #18 on: June 06, 2006, 07:37:27 PM »
Some people get drunk every day and die at the age of 80...That is worse for the liver than any hiv med.
The only member in these forums approved by WINBA: World International Nail and Beauty Association.
Epstein Barr +; CMV +; Toxoplasmosis +; HIV-1 +.
Counts when starting treatment:
V.L.:80.200 copies. CD4: 25%=503
Started Sustiva-Truvada 14/August/2006
Last V.L.count (Oct 2013): Undetectable
Last CD4 count (OCT 2013): 52%= 933

Offline J.R.E.

  • Member
  • Posts: 7,126
  • Joined Dec-2003 Living positive, since 1985.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #19 on: June 06, 2006, 07:56:36 PM »
Some people get drunk every day and die at the age of 80...That is worse for the liver than any hiv med.


I guess that is why the doctor does liver function tests on me every 3 months. Make sure nothings going wrong.


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #20 on: June 06, 2006, 08:31:01 PM »
<<Acording to my Dr. resistance should not occur with a 100% adherence.>>

Apparently a lot of doctors say this. They are wrong. Moffie's post underscored this perfectly. The reason that statement bothers me is that it creates a situation where the patient is blamed, or shamed, by the doctor (or his fellow pozzies) when a drug regimen fails. Sometimes HIV mutates out from under a successful drug regimen. And the science behind HIV supports this.

When doctors place a burden on their patients to the tune of 98% adherence and toxic, life/personality/body changing side effects, pit them against a virus that mutates as fast as any virus ever studied, and then even insinuates that the patient is at fault for a drug resistance, it makes me testy. It creates an adversariual relationship that is anethema to progressive and optimistic treatment.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Optimistic

  • Member
  • Posts: 326
  • An Apple A Day Keeps The Doctors Away!
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #21 on: June 06, 2006, 08:35:28 PM »
this kinda makes me want to stay away from the meds....scary thoughts.  :-\

Justin
12/06 (Atripla): cd4 - 260; cd% - 33%; vl - 169
1/07 (Atripla): cd4 - 267; cd% - 38.1%; vl - 132
4/07 (Atripla): cd4 - 373; cd% - 33.9%; vl - <50
7/07 (Atripla); cd4 - 287; cd% - 35.8%; vl - <50
9/07 (Atripla); cd4 - 356; cd% - 39.5%; vl - <50
12/07 (Atripla); cd4 - 517

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #22 on: June 06, 2006, 08:48:22 PM »
Justin, steering clear of the meds because of potential side effects and eventual resistance is a little like not dating until you have planned the wedding. Nothing lasts forever, or works perfectly. And not everyone has the same experience.

The key is to stay alive until the next breakthrough. And then the next. and then the next.
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline StrongGuy

  • Member
  • Posts: 492
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #23 on: June 06, 2006, 10:13:21 PM »
Optimistic don't be scared of the meds for fear of resistance.

My doctor says the same thing about adherence as other people up top have said and if you are really adherent and treatment naive with little to no resistance, your chances of developing resistance are VERY LOW.

That's a fact based on studies and pans out in statistical analysis.

Optimistic I received a PM a few months ago from someone who said some of what he read from others about the meds and sides and resistance got him so scared that he ignored the situation and in that time developed extreme anemia from teh virus and came close to death. When he got on the meds he had no sides and he is doing well today and could kick himself for living in fear and not verifying.

Remember that what you read when it comes to medical advice on here sometimes is not always rooted in fact. You need to verify.

I'm a believer in having a good doctor who really knows his stuff and will give you the facts. And also remember that starting meds in 2006 is a whole different ballgame than those who started when HAART first came out.

STAY OPTIMISTIC!!!!!

And don't succumb to fear if you can avoid it.

Hope is important, and many of us are hopeful that we can and will live long lives and manage this disease on a daily basis. I don't base this on wishful thinking, but the facts.

Best,
Mikey
« Last Edit: June 06, 2006, 10:15:22 PM by StrongGuy »
"Get your medical advice from Doctors or medical professionals who you trust and know your history."

"Beware of the fortune teller doom and gloomers who seek to bring you down and are only looking for company, purpose and validation - not your best physical/mental interests."

"You know you all are saying that this is incurable. When the real thing you should be saying is it's not curable at the present time' because as we know, the great strides we've made in medicine." - Elizabeth Edwards

Offline DingoBoi

  • Member
  • Posts: 1,355
  • Bailey's Infected Cream™ Served since 2004
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #24 on: June 06, 2006, 10:27:08 PM »
strong, i would be very interested in reading those supposed studies.

It is my belief that even on a dedicated 100% regimen, one will eventually become resistant to it. 

It is my understanding that the way the virus mutates over time may cause this even in non-resistant and with 100% adherence... I think it's just a factor of time.

Whether that be many years or a few years, I think it is the eventual outcome of all meds.   

Please post links to your 'facts'. 

Luckily in this day and age, we have many treatment options... but not nearly enough or effective enough for all.

But for the original poster, don't be afraid of starting meds because of resistance... new drugs will be coming down the pipeline.  It's important not to 'burn thru' the options, but taking meds for an average person will give them very many years of health.  and if you ever become resistant to them all... there will be more meds... adherence is definitely very important but by the time you might burn thru all the meds, at least 10 years will have passed and we will have some new options hopefully. (not to say you will burn thru them... but adherence is important) 

Offline StrongGuy

  • Member
  • Posts: 492
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #25 on: June 06, 2006, 10:46:21 PM »
Based on ten years of data available, and looking at highly adherent individuals with maintained undetectable viral loads, I was told the data shows their chances of future resistance is very low. My doctors over the years who've said the same thing could be lying, but I doubt it and trust them  :o

Dingoboy you should definitely verify and I'm sure if you check with your doctor or people in the field they hopefully they can pull up the information for you. (not my job or desire to do it for you.)

I'm also skeptical of much of what I read here too from people when it comes to medical advice and look for answers based on facts and scientific statistical studies, not anecdotal observations or feelings.

Happy searching...
Best,
Mikey   ;D
« Last Edit: June 06, 2006, 10:48:30 PM by StrongGuy »
"Get your medical advice from Doctors or medical professionals who you trust and know your history."

"Beware of the fortune teller doom and gloomers who seek to bring you down and are only looking for company, purpose and validation - not your best physical/mental interests."

"You know you all are saying that this is incurable. When the real thing you should be saying is it's not curable at the present time' because as we know, the great strides we've made in medicine." - Elizabeth Edwards

Offline DingoBoi

  • Member
  • Posts: 1,355
  • Bailey's Infected Cream™ Served since 2004
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #26 on: June 06, 2006, 10:52:33 PM »
I'm glad your doctors told you that and you trust them.  It's imperative to have a good relationship with your doctor.

Quote
Dingoboy you should definitely verify and I'm sure if you check with your doctor or people in the fieldthey hopefully they can pull up the information for you. (not my job or desire to do it for you.)

Actually, if you wish to make claims of 'fact' here, it IS your responsibility to post references for it.  Till then, it must be presumed as your opinion.  As I stated in my response to you.. it is my opinion that resistance will eventually develop regardless of what one does.

You state supposed facts without any references or sources and even did so in bold as if it makes it that much more factual.  Well, bold doesn't make it more factual.  It still remains your opinion and only your opinion, which you are entitled to.

Please don't state things as fact when you don't know they are.


Offline StrongGuy

  • Member
  • Posts: 492
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #27 on: June 06, 2006, 10:57:49 PM »
It's a fact based on the facts cited by what my doctors told me.

You don't want to believe it or want to call it an opinion, do whatever your heart desires. I couldn't care less.

And seriously don't tell me how or what I should post or my use of BOLD letters. Since when are you the diary police?

I'll post whatever I please and use whatever words I want anytime of the day dingoboyboy.

Peace and love  :P
Mikey
"Get your medical advice from Doctors or medical professionals who you trust and know your history."

"Beware of the fortune teller doom and gloomers who seek to bring you down and are only looking for company, purpose and validation - not your best physical/mental interests."

"You know you all are saying that this is incurable. When the real thing you should be saying is it's not curable at the present time' because as we know, the great strides we've made in medicine." - Elizabeth Edwards

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #28 on: June 06, 2006, 11:00:54 PM »
Strong, surely you realize that in the same post where you dismiss anecdotal evidence, you choose not to provide quantification, thus providing, well, anecdotal evidence.

Which is legitimate in a support forum, absolutely. But it provides little in the way of data.

Also, like I mention, it more than implies culpability - even blame - on the part of the patient, which should absolutely not be encouraged.

I feel badly for people who, based on reading the personal experiences here on aidsmeds, become too frightened to care for themselves. I do not, however, believe that the answer should be to censor ourselves or each other. Should those of us who have been sick refrain from discussing our situations for fear of scaring others? Most of us are careful to point out that our experiences are our own, and that other people's mileage might vary. This site is dedicated to facts. Some of them are sobering. But honesty should take precedence.

I believe it is important to quantify answers, especially when discussing a scientific topic.

The plural of anecdote is not data.

Just saying.
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline StrongGuy

  • Member
  • Posts: 492
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #29 on: June 06, 2006, 11:11:33 PM »
JK I thought we were going to ignore each other?

So much for that.

You and dingoboyboy who don't get along with me and any others can choose to not believe me and I wholeheartedly understand and I  believe everyone should verify what anyone says regarding medical advice or HIV population assumptions with their doctors or people in the scientific field. That's very important because there is at times muchf misinformation from people on here.

If you think I should provide a link to studies that my doctors cited in his office for which a layman like me has no link to, well then your poop out of luck on that one.

Sorry  :'(

 :P  :P Love ya  :P  :P
             Mikey
"Get your medical advice from Doctors or medical professionals who you trust and know your history."

"Beware of the fortune teller doom and gloomers who seek to bring you down and are only looking for company, purpose and validation - not your best physical/mental interests."

"You know you all are saying that this is incurable. When the real thing you should be saying is it's not curable at the present time' because as we know, the great strides we've made in medicine." - Elizabeth Edwards

Offline DingoBoi

  • Member
  • Posts: 1,355
  • Bailey's Infected Cream™ Served since 2004
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #30 on: June 06, 2006, 11:14:18 PM »
Quote
That's a fact based on studies and pans out in statistical analysis

You don't know it's a fact.  You are going by what other people (even though they may be doctors) have told you.   You don't know it 'pans out' in statistical analysis, because, as is obvious to the rest of us, you haven't seen those studies.

Quote
You and dingoboyboy who don't get along with me and any others can choose to not believe me and I wholeheartedly understand and I  believe everyone should verify what anyone says regarding medical advice or HIV population assumptions with their doctors or people in the scientific field. That's very important because there is at times muchf misinformation from people on here.

If you think I should provide a link to studies that my doctors cited in his office for which a layman like me has no link to, well then your poop out of luck on that one.

It's very important to verify information, which you apparantly haven't done.  I fail to understand why you would state something as 'fact' that you obviously have no method of knowing.  If you had stated 'my doctor told me...', I would not have disagreed with you, as that is your experience, but you chose to state something as fact when you have no idea if it is or isn't.  Flat out, you are wrong in your statements of 'fact' when you have no idea of their validity.

So, essentially, you are going upon your opinion and your opinion only.   Just like I am which I did state that it was only my opinion that 'resistance is inevitable'.

I feel you are entitled to your opinions.   We all are and that is a blessing on this forum, but if you choose to state something as fact here, please be prepared to back it up... which, frankly, you cannot or are unwilling to do, so your initial statement of the 'fact' must be completely dismissed.

And my name is Dingoboi... learn it, love it or don't bother mentioning it.   I presume you are using a purposeful misspelling of my name to 'annoy' me.  You have done it several times before and, frankly, it's kinda sad that you use such tactics.


« Last Edit: June 06, 2006, 11:19:58 PM by DingoBoi »

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #31 on: June 06, 2006, 11:18:02 PM »
<< There have been some studies showing that resistance develops even at undetectable levels. Others show it can occur even with 100% adherence. Researchers are searching for the mechanisms that allow this to happen.>>

http://www.thebody.com/tpan/novdec_02/resistance.html

<< there is some evidence that resistance can emerge slowly in people with undetectable viral load. Studies into long-term suppression of HIV due to antiretroviral therapy have found evidence of viral replication and mutation (Furtado 1999; Zhang 1999). It is now believed that antiretroviral therapy cannot eradicate HIV from the body completely, and that HIV continues to reproduce at low levels despite treatment. This raises the prospect of resistance emerging even among people with very low levels of HIV in their blood. This may, in turn, lead to treatment failure and viral rebound.

A Swedish group confirmed that resistance mutations do emerge among people with viral loads between 50 and 500 copies/ml (Soderborg 1999).
>>

http://www.aidsmap.com/en/docs/DA8A3956-EE1A-4726-867E-5F1CC2E04E91.asp


Perfect adherence greatly extends the life span of an antiviral regimen, but it appears that most of us will develop some resistance at some point, regardless. The key seems to be holding it off as long as possible, while newer and better therapies are developed.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Eldon

  • Member
  • Posts: 2,664
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #32 on: June 06, 2006, 11:24:08 PM »
I'm going to go with Dingo on this one. Adherance (taking your drugs on time) everyday as scheduled is your best bet.

My docotor stresses the fact of taking my meds everday as scheduled to do so.

Eldon

Offline StrongGuy

  • Member
  • Posts: 492
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #33 on: June 06, 2006, 11:27:26 PM »
Good information JK

Your data verifies an aspect of this discussion I never disagreed with.

Like I said, the data I was shown shows the development of resistance with undetectable viral loads and high adherence is VERY LOW based on teh ten years of knowledge we have from HAART.

No one is saying resistance can't happen and will happen to people in this segment of the population. I'm just saying it's very low.

Isn't The Body a great resource? I have access to the Body Pro too which is even better.

I'm in LOVE with Dr. Pierone and Doctor Daar. They are my Idols.

Good stuff...

Love ya  :P :P
Mikey

"Get your medical advice from Doctors or medical professionals who you trust and know your history."

"Beware of the fortune teller doom and gloomers who seek to bring you down and are only looking for company, purpose and validation - not your best physical/mental interests."

"You know you all are saying that this is incurable. When the real thing you should be saying is it's not curable at the present time' because as we know, the great strides we've made in medicine." - Elizabeth Edwards

Offline allopathicholistic

  • Member
  • Posts: 3,258
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #34 on: June 06, 2006, 11:31:31 PM »
it appears that most of us will develop some resistance at some point, regardless.

 :( that makes me sad. ack, i'm probably just over-emotional at this midnight hour. hope my current successful trio will last for YEARS AND YEARS. am i asking for too much?
« Last Edit: June 06, 2006, 11:33:28 PM by allopathicholistic »

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #35 on: June 06, 2006, 11:37:57 PM »
For many, many people, one regimen lasts for years and years. Decades even.
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Robert

  • Member
  • Posts: 2,644
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #36 on: June 06, 2006, 11:43:34 PM »
Yes, I think resistance is futile.


Quote
There have been some studies showing that resistance develops even at undetectable levels. Others show it can occur even with 100% adherence. Researchers are searching for the mechanisms that allow this to happen.

Although I have been undetectable for 3 years I explained to my Dr how I still could still "feel" the virus in my system.  I told her about my memory lapses and sometimes just a total feeling of being "lost in space."  I told her I had this feeling that the virus plays "Hide and Seek" when it comes to test for the viral load.  She told me there are places deep in the crevices of the mind that HAART cannot access. 

Quote
there is some evidence that resistance can emerge slowly in people with undetectable viral load.

I think that's what happens when you can't flush your system completely clean.

robert
« Last Edit: June 06, 2006, 11:54:56 PM by Robert »
..........

Offline StrongGuy

  • Member
  • Posts: 492
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #37 on: June 06, 2006, 11:45:49 PM »
Perfect adherence greatly extends the life span of an antiviral regimen, but it appears that most of us will develop some resistance at some point, regardless. The key seems to be holding it off as long as possible, while newer and better therapies are developed.

JK I can't find that statement anywhere in the artical you cited. Is this your personal analysis or is there something I am missing? Just looking for clarification.

What I  did find in the article is part of what Ive been saying:

The authors concluded that so long as complete adherence can be maintained over the long-term, today's drug regimens appear able to suppress viral replication for more than ten years (Phillips 1999).

Dingo boy boy honey love do as you please. Your diary policing and demands are tiring. You can't always get what you want. And I'm definitely not catering to your self-imposed citation rules. I'm a bad boy and reckless yadda yadda yadda. Whatever makes you happy.

Love ya  :P  :P
Mikey
« Last Edit: June 06, 2006, 11:49:36 PM by StrongGuy »
"Get your medical advice from Doctors or medical professionals who you trust and know your history."

"Beware of the fortune teller doom and gloomers who seek to bring you down and are only looking for company, purpose and validation - not your best physical/mental interests."

"You know you all are saying that this is incurable. When the real thing you should be saying is it's not curable at the present time' because as we know, the great strides we've made in medicine." - Elizabeth Edwards

Offline allopathicholistic

  • Member
  • Posts: 3,258
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #38 on: June 06, 2006, 11:48:31 PM »
For many, many people, one regimen lasts for years and years. Decades even.


oh please let that be me

Yes, I think resistance is futile.

resistance to resistance?   :P

Offline DingoBoi

  • Member
  • Posts: 1,355
  • Bailey's Infected Cream™ Served since 2004
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #39 on: June 06, 2006, 11:49:20 PM »
i will remove myself from this conversation except to correct any inaccurate statements made my stronguy.

Offline The Canuck

  • Member
  • Posts: 628
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #40 on: June 06, 2006, 11:50:54 PM »
Quote
The authors concluded that so long as complete adherence can be maintained over the long-term, today's drug regimens appear able to suppress viral replication for more than ten years (Phillips 1999).

It says '' appear '' and although this statement is correct, the facts are that it can vary a lot from one individual to another. Some people can last 10 years on the same regimen while others won't go over 3 and sometimes less. I'm certain there are a lot persons here who are at both extreme with some in the middle.

The Canuck

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #41 on: June 06, 2006, 11:54:34 PM »
My quoted statements are surrounded by these symbols: <<>>

I then provide the link to sourced material. Of course, anything without that encapsulation is my opinion. Though I doubtless can provide quantification for it.

http://www.retroconference.org/2005/CD/Abstracts/25873.htm

http://www.thebody.com/Forums/AIDS/Resistance/Archive/drug/Q167082.html

I too enjoy thebody.com pro. I have not had much time to delve into research here on the set.

One thing about this site that I dearly love is that we are optimistic not despite the fact, but because we have possession of them. There is nothing to be gained by promoting or encouraging ignorance.
« Last Edit: June 06, 2006, 11:58:07 PM by jkinatl2 »
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Robert

  • Member
  • Posts: 2,644
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #42 on: June 06, 2006, 11:59:41 PM »
I had to "edit" my first entry because I pushed the wrong button.  I hadn't finished what I wanted to say.  If you're interested in what I have to say, scroll back up.


thanks

robert
..........

Offline fearless

  • Member
  • Posts: 2,191
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #43 on: June 07, 2006, 12:03:49 AM »
hey let's all try and stay cam and not put unecessary fear into the original poster or other who may read.

[/size][/size]The best way to reduce the chance of resistance is simply to adhere to your regimen as closely as possible.

There was a period in the early 90's when there was a fear in the media that resistance was developing despite HAART therapies. There is an article about it on the body, which I've forgotten to reference I know, but it said whilst the results were valid one needed to look deeper and that the survey participants were all treatment experienced and most had taken AZT monotherapy, then dual combos before moving on to the then new triple combos - not the perfect way to start treatment, and adherence was much more difficult with the new treatments.
It is difficult to find any long term scientific research on triple combination therapies and whether drug resistance can/will occur if you adhere strictly to your regimen. I found an abstract for one: http://www.jaids.com/pt/re/jaids/abstract.00126334-200212153-00006.htm;jsessionid=GGKdsbzhYgtXG6n31fGcqP1CGTsG1cs12DZc0LFc9YXVvJGPRqdr!-818462210!-949856145!8091!-1, but they want $25 for the whole article. I'll be buggered if I'm gonna pay that. and a nice simple 'fact sheet' here: http://www.atdn.org/simple/resistance.html

steve
Be forgiving, be grateful, be optimistic

Offline StrongGuy

  • Member
  • Posts: 492
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #44 on: June 07, 2006, 12:05:07 AM »
Thank you for clarifying JK that the statement I asked about wasn't from the article and it was your statement.

JK I read both of your links and, while interesting, I don't see them backing up your statement in any way shape or form.

But they were informative nonetheless (though I heart Dr. Pierone and Dr. Daar and my hot ID doc even more.)

Love ya  ;D  ;D
Mikey
"Get your medical advice from Doctors or medical professionals who you trust and know your history."

"Beware of the fortune teller doom and gloomers who seek to bring you down and are only looking for company, purpose and validation - not your best physical/mental interests."

"You know you all are saying that this is incurable. When the real thing you should be saying is it's not curable at the present time' because as we know, the great strides we've made in medicine." - Elizabeth Edwards

Offline fearless

  • Member
  • Posts: 2,191
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #45 on: June 07, 2006, 12:06:46 AM »
Here is a really good simple article: http://www.aidsmap.com/en/docs/F349BF95-1805-48DB-952E-C2612DA40F3E.asp

And I quote:

Minimising the risk of resistance
It’s important to take anti-HIV drugs exactly as prescribed, by sticking rigidly to the recommended dose and timetable, and observing instructions about food. Taking too little drug (by missing or reducing doses) could allow drug levels in the blood to fall to inadequate levels, allowing viral replication to occur and increasing the risk of the emergence of resistance.

Using three or more anti-HIV drugs at once, known as combination therapy or ‘HAART’, delays resistance, because viruses that are resistant to one of the drugs may still be controlled by the others.

Studies have shown that the risk of viral load rebound is related to the lowest point to which viral load falls after starting treatment, called the ‘nadir’. The lower the nadir, the lower the risk of rebound, and therefore the risk of resistance. People whose viral load falls to, and remains below 50 copies are at a much lower risk of developing resistance. However, resistance may emerge even in these people over the longer term.

Adding or changing a single new drug in a combination which is not suppressing viral load is likely to lead to the development of drug resistance, because the impact of that single new drug is likely to be insufficient to block replication. Experts now advise that treatment changes in these circumstances should involve switching to a completely new combination, wherever possible.

Continuing with the same drugs after your viral load begins to go up can also encourage the development of resistance. This is because resistance to some drugs develops progressively; as more resistance mutations accumulate, sensitivity to the drug will fall. However, resistance to drugs emerges at different speeds. For example, 3TC, nevirapine and efavirenz resistance emerges very quickly, but d4T and ddC resistance emerges more slowly.
Be forgiving, be grateful, be optimistic

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #46 on: June 07, 2006, 12:18:50 AM »
I am sorry, strong guy, that the phrase

<<HIV resistance is the near inevitable consequence of failure of antiretroviral drugs to fully suppress viral replication in treated patients. >>

http://www.retroconference.org/2005/CD/Abstracts/25873.htm

escaped your attention.

My statement was:

Perfect adherence greatly extends the life span of an antiviral regimen, but it appears that most of us will develop some resistance at some point, regardless. The key seems to be holding it off as long as possible, while newer and better therapies are developed.

Which was supported by:

<< Most HIV physicians also have experience with patients who report the same faithfulness with the same regimen, only to experience virologic failure and resistance after months or years.

We have good evidence that virus evolution, with the development of resistance mutations, continues in the bloodstream and in 'sequestered sites' in the body such as the gonads and the central nervous system, even in patients with undetectable viral loads by standard viral load assays>>

http://www.thebody.com/Forums/AIDS/Resistance/Archive/drug/Q167082.html


"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline kcmetroman

  • Member
  • Posts: 567
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #47 on: June 07, 2006, 12:25:10 AM »
Quote
That's a fact based on studies and pans out in statistical analysis.


Someone help me....I went to click on the fact here and there was no link.  It was underlined? ???

Offline DCGuy511

  • Member
  • Posts: 61
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #48 on: June 07, 2006, 12:32:44 AM »
I'm relatively new to this disease. I went on HAART for a year using a PI and two NNRTIs. (I'm resistant to the NRTIs.)  I had great results, went to <50 within two months. My doc told me that he thought that combo would most likely last me a long time.  I asked about developing resistance. He said that it was always a possibility. We only have 10 years of HAART knowledge to study. I'm pretty sure that he was only speaking about me and my situation. For people who have been on treatment longer, especially before HAART, they have a much more complicated situation as they were once on mono therapy or a two drug regimen. Their resistance patterns are probably a lot different than someone who started drug therapy in the triple-cocktail days.  

IMHO, sometimes the "100% adherence = success" is a little simplistic. I think that when the docs say 100% adherence will make a success, they are saying that if you take the medication at the exact time intervals as prescribed and it gets into your blood stream as expected, it should work because it has in most people with similar situations.  But, what if the medication makes you ill and you throw it up? What if it makes you ill, gives you horrible diarrhea and runs right through you not being absorbed as intended? It is my understanding that in order to get FDA approval, recommended dosages of meds only need to work in a significant majority of the population. So let's say you are one of those people who is not as sensitive to the meds as the majority, and you happen to have orange juice (which shouldn't affect the absorption in most, but could in you), and the virus gets a little window where it can mutate. Here you are thinking that you are on-track when actually you are not.  My point it that there are no absolutes in medicine. The docs and the scientists take the knowledge they have and try to apply it to our individual situations. For many it will work, but not necessarily everyone. When I asked my near-retirement orthopaedist why he does surgery on one type of patient, prescription drugs on others, and physical therapy on yet another group, he replied, "Even patients with the same diagnosis are different people. Medicine is as much of an art as it is a science."

just my two cents.
steve

ps:  thanks for the comments re the hidden virus
« Last Edit: June 07, 2006, 12:34:37 AM by DCGuy511 »
Steve
Infected/Diagnosed Fall 2003
"No Man Is An Island" - J Donne

Offline HIVworker

  • Member
  • Posts: 918
  • HIV researcher
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #49 on: June 07, 2006, 12:42:38 AM »
Wow, what a topic.

Let me add my perspective, for what it is worth...

HIV therapy does fail...if it didn't then HIV therapy would have led to the cure. Yes, it is true that strict adherence might lead to fewer resistance variants, but is what the medical community doing enough...from the answers here, it must be "no".

While it is less likely to get resistance based on exact adherence to therapy, the result is not complete eradication. Therefore by extraction, current therapy is not good enough. I agree it is futile to blame patients for non-adherence as that deflects the blame of the failure of current therapy from us to you.

What do we really need? A cure.

No longer can we be satisfied with treatments that prolong the disease. What is required is a cure, In the absence of that we require viable therapy. New targets for drug therapy represent good progress, but are not the final solution. I'm not trying to burst anyone's balloon here - therapy is better than it was. However, therapy is a long way from where it needs to be. Erradi cation, and not the suppression of virus, is what is needed. We can slap ourselves on the back and claim we have made a difference and blame patients if we like. However, despite our best efforts the virus remains out there and therefore our best efforts are not enough. The time for viral suppression is over. Eradication has to be our buzz-word. While I champion the efforts of new drug targets, this merely perpetuates the problem and doesn't solve it.

Is current HAART useless? No. Could we do better? You betcha!

I agree with the pessimistic voices here....that HAART is good but even with strict adherence it isn't the answer. Erradi cation in a manner we haven't tried is. I advocate all therapies that look at that.

It's time for an end to the hitting of moles at the carnival. Time to make a difference to the disease.

R
NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

Offline kcmetroman

  • Member
  • Posts: 567
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #50 on: June 07, 2006, 12:42:59 AM »
What it all boils down to is that each and every one of our structures are different.  Facts are based on past happenings and present potentials.  What is good for Jimmy aint always doin it for Joey.  I have been on meds for a year.  I have never missed a dose, and not even by more than an hour and a half.  I have been undetectable since my very first screening after a VL of over a million.

I will continue to take those meds as long as they work.  I started a thread on a lab fuck up that showed me at 92,000.  Thank god it wasn't correct, but I was making plans for a new cocktail. I will do whatever I have to do.

Because I saw what it was like on the other side.

Offline aztecan

  • Member
  • Posts: 5,394
  • 29 years positive, 57 years a pain in the butt
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #51 on: June 07, 2006, 12:45:34 AM »
Well, hell, I may as well weigh in on this.

I recently posted I celebrated my 10th anniversary on the same med regimen. I wouldn't wish my regimen on anyone (AZT, Epivir, Crixivan). Cocktail anyone?

But it was the best we had back in 1996 and it works. In July, I will have been undetectable for 10 years.

That is, if my viral load is still undetectable. There are no guarantees.

As Tim (Moffie) said, I believe the answer to the original question is yes, the virus will eventually mutate and force me to switch my regimen.

Have I been 100 percent adherent? With Crixivan, are you serious? But, I am probably in the 98 to 99 percent adherence level.

As has been pointed out, the virus does hide in some spots (lymph nodes, brain, central nervous system, anal secretions, etc.) Some drugs cross some of the barriers to reach some of these locations (AZT crosses the blood/brain barrier), but there will always be a reservoir somewhere where this little bugger will hide and do what come naturally for it.

There are so many variables it would be impossible for anyone to predict how long a regimen will last. Some people like myself seem to last a long time on the same cocktail. Others develop resistance even with 100 percent adherence.

All we can do is continue to fight as best we can, working with what we've got. Things have really improved since I started my regimen, I hope that continues and someday there is a breakthrough that may allow us to live normally and, as HIV worker said, without drugs.

Until then, I'll keep popping my pills, scheduling my meals around my pill times, keep monitoring my CD4s and viral loads and do whatever I can to enjoy life.

HUGS,

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #52 on: June 07, 2006, 12:50:31 AM »
Here are a couple of other Aidsmap articles related to this issue:

Limiting the chance of resistance

What level of adherence is necessary?

Offline HIVworker

  • Member
  • Posts: 918
  • HIV researcher
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #53 on: June 07, 2006, 12:51:34 AM »
I agree with that last post, but add crude food for thought. Is the fact that you have to take three sets of drugs to potentially keep HIV at bay...at best "Bollocks"? The side effects, the adherence, the reminders of HIV? Therapy is failing the HIV positive community. No? It's far from crap,  but it's also far from acceptable.

R
NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #54 on: June 07, 2006, 01:25:31 AM »
I am sorry, strong guy, that the phrase

<<HIV resistance is the near inevitable consequence of failure of antiretroviral drugs to fully suppress viral replication in treated patients. >>

http://www.retroconference.org/2005/CD/Abstracts/25873.htm

escaped your attention.

My statement was:

Perfect adherence greatly extends the life span of an antiviral regimen, but it appears that most of us will develop some resistance at some point, regardless. The key seems to be holding it off as long as possible, while newer and better therapies are developed.

Which was supported by:

<< Most HIV physicians also have experience with patients who report the same faithfulness with the same regimen, only to experience virologic failure and resistance after months or years.

We have good evidence that virus evolution, with the development of resistance mutations, continues in the bloodstream and in 'sequestered sites' in the body such as the gonads and the central nervous system, even in patients with undetectable viral loads by standard viral load assays>>

http://www.thebody.com/Forums/AIDS/Resistance/Archive/drug/Q167082.html


JK:

I am trying to follow your train of thought here.  It appears that you might be misinterpreting the intent of this statement: "HIV resistance is the near inevitable consequence of failure of antiretroviral drugs to fully suppress viral replication in treated patients."  What it is saying is if an antiretroviral regimen fails to maximally suppress viral replication (i.e, viral load remains detectable above 50), then resistance is likely to happen.  This is irrespective of what causes the treatment to fail to suppress the viral load to less than 50: it could be due to incomplete adherence (which could be from missing doses, or inability to take the meds due to side effects, or other reasons), it could be due to pre-existing acquisition of resistant strains that was not detected and have faded in the background and then re-emerged after the drugs were started, or in some situations, the regimen simply fails to suppress the viral load maximally in spite of perfect or near perfect adherence.  Thus, it is the treatment failure that causes the subsequent development of resistance.  On the flipside of it, individuals who are able to suppress the viral load maximally to <50 have the best chances of having a durable treatment response for many years for as long as they are able to tolerate and adhere to the regimen. 

This is also in the same line as what was in this conclusion which you likewise quoted: "A Swedish group confirmed that resistance mutations do emerge among people with viral loads between 50 and 500 copies/ml (Soderborg 1999)."  Remember that viral loads consistently above 50 (which includes the 50-500 range) in the setting of HAART actually do represent treatment failure.  This is the reason why treatment success is gauged as achieving and maintaining viral loads at less than 50.  So in the former setting (viral load range 50-500), there is in fact a greater chance of development of resistance to meds being taken compared to someone taking the exact same meds and who is able to keep the viral load consistently < 50.

Finally, you chose this quote from Dr. Sherer with his response to a similar question: "Most HIV physicians also have experience with patients who report the same faithfulness with the same regimen, only to experience virologic failure and resistance after months or years.  We have good evidence that virus evolution, with the development of resistance mutations, continues in the bloodstream and in 'sequestered sites' in the body such as the gonads and the central nervous system, even in patients with undetectable viral loads by standard viral load assays."

In the interest of fairness and balance, I think we also need to present here the next paragraph of his response: "However, in spite of this evidence, we have many instances of prolonged successful suppression, like your case. Apparently ongoing evolution as I've described it does not inevitably lead to clinically significant viremia, resistance, and virologic failure. It may be that the low level development of resistant clones is adequately managed in some people by one or two of the active drugs in an active three drug regimen, in spite of the resistance to one of the drugs, as well as their immune system."

These articles were NOT suggesting that the emergence of resistance during antiretroviral treatment is inevitable and I hope that was not what you concluded from reading them (although it could easily be misinterpreted that way) nor that it was the message you were trying to convey.

Gerry

P.S.  It also does not imply that just because a regimen fails and emergence of resistance develops that the reason for such is non-adherence.  It is one of the things that can lead to treatment failure but is not by any means the only reason for it.
« Last Edit: June 07, 2006, 02:00:42 AM by gerry »

Offline StrongGuy

  • Member
  • Posts: 492
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #55 on: June 07, 2006, 01:50:39 AM »
Gheez I go work out and I miss all the fun.

Great information I must say!

<<HIV resistance is the near inevitable consequence of failure of antiretroviral drugs to fully suppress viral replication in treated patients. >>

JK I'm not disputing that statement.

What the article author means by "fully suppress" (undetectable w/ ghastly reservoirs or low viral load low still above above 50 copies) is not clear from that article.

(Basically what I just noticed Gerry wrote above when I was about to post this.)

But building on HIV workers great insights, I do agree that there are a lot of unknowns. But from ten years of data comparing those who are strictly adherent and undetectable to those who aren't, the emergence of resistance is low.

Will it take 40 years or 30 years for some and eventual resistance even the most adherent and virologically suppressed? I guess we'll all know then.  No way to know when all we have is ten years of data onHAART. But the odds for decades is good for many with little resistance and great adherence/suppression.

The important thing I take from all this is that adherence and vigilance is important. Also, that we should remain hopeful for better treatments on the horizon!

Ciao bellos and bellas!
Mikey  :-*  :-*
"Get your medical advice from Doctors or medical professionals who you trust and know your history."

"Beware of the fortune teller doom and gloomers who seek to bring you down and are only looking for company, purpose and validation - not your best physical/mental interests."

"You know you all are saying that this is incurable. When the real thing you should be saying is it's not curable at the present time' because as we know, the great strides we've made in medicine." - Elizabeth Edwards

Offline randym431

  • Member
  • Posts: 1,121
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #56 on: June 07, 2006, 06:13:55 AM »
Good subject. I think fear of resistance is always in the back of our minds. I just go by those few I personally know, long term on meds. None have developed resistance having been on meds for 8 years to 10 years. And these latest drugs are better than ever before. So I guess why worry if you follow the directions. It may happen but doubtful for most. I try not to worry about things that could but havent happened. If you do, it can itself drive you nutz.

Offline newt

  • Member
  • Posts: 3,878
  • the one and original newt
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #57 on: June 07, 2006, 07:17:10 AM »
A study by Andrew Phillips, looked at results from resistance tests of people in London/Brighton who were using combinations of three of more drugs:

Between1996 and 2003, around 4,500 patients started combo with 3 or more drugs. Just over half started with an non-nuke (eg Sustiva), the rest with  a protease inhibitor. The cumulative risk of virological failure (two viral loads of more than 1,000 after 24 weeks from start of combo) was 24% by 2 years, 34% by 4 years and 42% by 6 years.

Risks by 6 years for class-specific mutations were:

- M184V/I 18%,
- 1 or more TAM 15%
- Non-nuke 17%  overall. BUT 25% for people who started with a non-nuke
- PI 8% overall, 10% for people who started with a PI

Q: What does this mean then, newt?

0. Global figs, not very well developed in terms of adherence, length of infection etc.

1. M184 is the "classic" nuke mutation that leads to 3TC resistance.  But this may not be that important treatment-wise, cos lots of other nukes are more effective against M184V strains, and it may be a preferable (eg more weedy) strain to have.....

2. Starting on Sustiva? That's a high chance of resistance.  It takes no account of (a) adherence (b) pre-existing but undetected non-nuke resistance.  I would like to see a more sophisticated (adherence controlled, genotype controlled) breakdown.  Non-nuke resistance is usually sudden death.  PI resistance is more subtle, rather like the gradual erosion of a cliff by the ocean.  The PI nos are for  'old' combos ie nothing newer than Kaletra.

4. Life never matches the science.  I have a colleague who  religiously took hisSustiva/Combivir to the minute and got an across the board flat-out nuke + non-nuke resistance.  And an older friend who's only ever done 3TC + 1 other nuke (1st ddI, now abacavir) and is happily undetectable and has been forever (since 1997).  My ex got resistant to Sustiva after 2 1/2 yrs (cos it was tripping him out and he was skipping doses perhaps...) + some ddI resistance, but is undetectable on a PI + Truvada.

5. People may also like to consider that infection with resistant virus is not associated with more rapid disease progression, so writes Ian Frank MD for HIV & Hepatitis.

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

Offline ademas

  • Member
  • Posts: 1,151
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #58 on: June 07, 2006, 08:22:16 AM »
...because the more I read, the more I don't know what to think.


amen.
and yes, I quoted myself.

xox

Offline Christine

  • Member
  • Posts: 1,069
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #59 on: June 07, 2006, 11:00:38 AM »
Hello,
From my understanding and personal experience- yes. I am pretty much resistant to most of the meds, even with very close to 100% adherence. I eat well, don't do recreational drugs, don't drink, smoke, exercise...everything one is supposed to do to help, and I still have resistance. There are a small % of people who this happens to. It can be really frustrating.
Christine
Poz since '93. Currently on Procrit, Azithromax, Pentamidine, Valcyte, Levothyroxine, Zoloft, Epzicom, Prezista, Viread, Norvir, and GS-9137 study drug. As needed: Trazodone, Atavan, Diflucan, Zofran, Hydrocodone, Octreotide

5/30/07 t-cells 9; vl 275,000

Offline heartforyou

  • Member
  • Posts: 1,105
  • I must be a survivor in many ways...
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #60 on: June 07, 2006, 11:04:23 AM »
Yes, definitely yes.

I have gotten resistant to most of the available drugs, in spite of very good adherence.

My doc has always told me I have a very aggressive strain that  mutates a lot.
Still, I am undetectable since 1997 and on my current schedule for 1 year.

hermie
« Last Edit: June 07, 2006, 11:16:57 AM by heartforyou »
Diagnosed in 1987 and still kicking
Viread, Kivexa (Epzicom),Viramune once daily

Happiness is the freedom of breathing fresh air every day.

Offline DCGuy511

  • Member
  • Posts: 61
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #61 on: June 07, 2006, 11:18:51 AM »
Is the fact that you have to take three sets of drugs to potentially keep HIV at bay...at best "Bollocks"? The side effects, the adherence, the reminders of HIV? Therapy is failing the HIV positive community. No? It's far from crap,  but it's also far from acceptable.

R

Well, I do not think it is at best bollocks. We've yet to find the magic single drug that will wipe out HIV, but I am sure a lot better off then the thousands that died before the discovery of HAART.

The number of drugs does not bother me. I have a friend who is really excited about those combination pills that will combine three drugs in a pill he takes twice a day.  Personally, my cocktail involved two prescriptions, 4 pills 2x/day. Adding that to the allergy meds, prostate meds, & ADs that I take everyday was not that hard to do.  I hated the side affects. For me, I wish they'd concentrate on the side affects issue.  Compare that to another friend of mine, been poz since 85, he's on a three drug regimen where only one med is actually working, the other two are just "holding back the floodwaters," says his doc. Lucas is in desperate need of a new class of drugs, I'd prefer that science find the new class for him before dealing with my side-affects issue.

I have a lot of confidence in the scientific community. They'll keep creating new classes of drugs, easier dosing of existing drugs and eventually will discover the holy grail, therapeutic and preventative vaccines.
Steve
Infected/Diagnosed Fall 2003
"No Man Is An Island" - J Donne

Offline HIVworker

  • Member
  • Posts: 918
  • HIV researcher
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #62 on: June 07, 2006, 04:48:46 PM »
Yes, definitely yes.

I have gotten resistant to most of the available drugs, in spite of very good adherence.

My doc has always told me I have a very aggressive strain that  mutates a lot.
Still, I am undetectable since 1997 and on my current schedule for 1 year.

hermie

What does your doctor base that explanation on? Just the fact you have been taking meds and are resistant or do they actually have some evidence? I guess my question is, "Does he/she really know?

R

PS. Sorry about my writings last night. Not very professional.
NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

Offline StrongGuy

  • Member
  • Posts: 492
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #63 on: June 07, 2006, 06:21:36 PM »

I was just doing my daily scan of The Body's "As the Experts" forum and, low and behold, I came upon the following question and answer posted just today on this very topic:

Quote

Subject: Duration of Drug Combos
The Body's "Ask The Experts" Forum
Jun 7, 2006

Question:
For persons who are trying treatment now for the first time with at least a 250 t-cell count, how long does a drug regimen usually last before becoming drug resistant? two years? 5 years? 10 years? longer? Thanks for your answer.

Answer:
Benjamin Young, M.D., Ph.D, University of Colorado Medical Center

Thanks for your post.

Patients who remain optimally adherent to a well chosen (by baseline resistance testing) HAART regimen have a greater than 90-95% of having success. Adherence is much more important than baseline CD4 counts (at least in this range) in predicting the rate of treatment failure or drug resistance.

For patients who have viral suppression after the first year of treatment, it's very, very rare to see failure and resistance in subsequent years. BY


Here is the direct link: http://www.thebody.com/Forums/AIDS/Meds/Current/Q175235.html

It was good to see another confirmation of what I've been told numerous times by my doctors. Always verify!!!!

Ciao!!!!
MIkey


"Get your medical advice from Doctors or medical professionals who you trust and know your history."

"Beware of the fortune teller doom and gloomers who seek to bring you down and are only looking for company, purpose and validation - not your best physical/mental interests."

"You know you all are saying that this is incurable. When the real thing you should be saying is it's not curable at the present time' because as we know, the great strides we've made in medicine." - Elizabeth Edwards

Offline heartforyou

  • Member
  • Posts: 1,105
  • I must be a survivor in many ways...
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #64 on: June 07, 2006, 06:41:55 PM »
HIV worker

It all started when I first got on meds in 1995.
I remember I first got on AZT. after about one year that therapy failed, although I never missed a dose.
On the next one I got a toxic hepatitis and had to switch.
After having stopped for several weeks I started again, and had to switch several times again.
Sustiva made me act like a mad man.

What I mean is that I would have to ask what evidence they have for the mutations.
But I know there is some.
And I always heard : you have a very aggressive strain that constantly mutates.

When you are really interested I can ask for my files.

Hermie

Hermie
Diagnosed in 1987 and still kicking
Viread, Kivexa (Epzicom),Viramune once daily

Happiness is the freedom of breathing fresh air every day.

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #65 on: June 07, 2006, 11:55:13 PM »
If one goes back to the original question "Can resistance still occur even with 100% adherence?" this can easily be answered with a yes.  This is partly because not all regimens will be successful in suppressing the viral load down to undetectable (<50).  So for those who continue to have detectable viral loads in spite of being adherent to a drug regimen, then there is a possibility of developing resistance down the road.  The more difficult thing to answer is how long one can expect a particular regimen to be successful in keeping the viral load to <50, which offers the best chances of not developing resistance.  This is of course due to several reasons, the most obvious of which is we only have 10 years of HAART history to rely on.  Even with that 10 year history; there is a big difference between HAART in the earlier years and HAART in the later ones. Other factors include the heterogeneity of individuals going on HAART (some are treatment naive, while some are treatment experienced), and the multiple combinations of drugs that have become available.  Therefore, epidemiologic studies in the so-called HAART era such as the one provided by Matt (thanks Newt!) is applicable only for the time frame that the data is collected.

For instance, the report by Pillips which observed 4500 patients in the UK from 1996 to 2003 and calculated the risk of treatment failure to be 24% by 2 years, 34% by 4 years and 42% by 6 years is quite sovering.  But this does not mean that one will see a similar picture if they looked at another cohort that just started ARV's say beginning from 2000 to the present.  In other words, past performance is not a guarantee of future results.

Take for instance the GS903 trial which started in 2000 and was one of the studies that got Viread approved.  Patients in the Viread/3TC/Sustiva treatment arm (in Brazil, Argentina and the Dominican Republic) were observed for an additional 2 years after the first 2 years of the trial were concluded.  At the 4 year mark, the proportion of patients with VL < 400 was 95% by on-treatment analysis and 91% by intent-to-treat (missing = faililure analysis); the proportion of patients with VL < 50 was 92% by on-treatment analysis and 87% by intent-to-treat (missing = failure analysis).  Granted that this has a much smaller sample size (86), but this gives a much more different picture from the 34% failure rate by year 4 quoted in the epidemiologic study above.
« Last Edit: June 07, 2006, 11:58:24 PM by gerry »

Offline Matty the Damned

  • Member
  • Posts: 12,228
  • Ninja Please
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #66 on: June 08, 2006, 12:17:00 AM »
Clearly the answer is yes. Resistance develops even with 100% compliance.

This underlines the point that current treatments are not a cure. Just a method of management for a set period of time. HIV infection is still ultimately a fatal condition for the vast majority of us who have it.

MtD

Offline HIVworker

  • Member
  • Posts: 918
  • HIV researcher
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #67 on: June 08, 2006, 12:19:06 AM »
Hermie,

I do not doubt that there are HIV mutations that bear resistance. What I am wondering is about this highly mutating strain. I am not doubting that it is possible, but I was wondering if they had any evidence other than the resistance occured even with strict pill-taking. It does occur, but in order to study why HAART fails requires an understanding as to why. I've heard of highly mutating strains but not really seen the evidence. To be so would require mutations in RT that make it more sloppy or a strain that can replicate better in places HAART can't currently go. My motivation was to ask what evidence your doctor gave you, if any, as this might help improve HAART therapy.

R
NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #68 on: June 08, 2006, 12:42:51 AM »
I am concerned about the necessity for insisting that adherence will always equal success. Not only does that set up a patient for self-reproach in the event that resistance occurs, it sets a precedent in the HIV community where getting sick becomes "your own fault." That's not optimism. That's elitism.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #69 on: June 08, 2006, 01:26:09 AM »
I am concerned about the necessity for insisting that adherence will always equal success. Not only does that set up a patient for self-reproach in the event that resistance occurs, it sets a precedent in the HIV community where getting sick becomes "your own fault." That's not optimism. That's elitism.
I understand your concern.  May I ask what advice you would give someone who has never been on treatment  and who is about to start treatment?

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #70 on: June 08, 2006, 01:58:46 AM »
I would suggest that they examine not only the drugs, but the life into which a drug regimen is about to be inserted. As it stands, these drugs are to be taken on time, every day, for the rest of a person's life. Until and unless a person truly feels ready for this committment, side effects and all (the long term side effects are only now beginning to surface) then they absolutely must not be bullied into drug therapy.

A social network, either on or offline, where the person can present any potential problems and discuss side effects, adherence, et al without fear of recrimination is vital. It is my firm belief that this site can provide part of that, for those who seek it. But only if we do not gloss over the negative aspects in our zeal to provide optimistic support.

Support which ignores factual data is a lie. And such a monumental decision should never be based on a lie. If this scares someone, I am sorry about that. HIV is a scary disease. One of the scariest. Being scared is not only understandable, it is the normal response to such a life-altering situation. Thing is, to provide the information AND the support in such a way that a person can make up his/her mind about when the time is right --- if ever --- to start, change, stop, or resume treatment.

But it's my opinion that setting people up to fail by withholding or ignoring evidence is not being supportive. And neither is the insinuation that drug resistance is a patient's fault. HIVWorker spoke quite eloquently regarding this topic, and the actual experiences of people like Moffie, Joe, and others.

These drugs, when used optimally, often work miracles. But sometimes they fail. And sometimes they fail regardless of adherence. Why am I being a pessimist when I state that simple fact? Without locking patients up and monitoring their adherence, we have only patient report combined with lab/primate study to base our percentages on. And that's close to conjecture, albeit learned conjecture.

Would I suggest that a person learn all they can, not only about their drugs but about their disease, before starting treatment? Absolutely. And sometimes part of that education is discerning when a person is ready to make that committment, and what boundaries they are going to establish. Do they switch drugs which suppress viral replication because these drugs also cause facial wasting or fat redistribution? Do they change or stop meds because the emotional side effects render them paranoid or suicidal? Do they stop or change treatment because of the relentless diahrrea? Everyone has a breaking point, a point at which they can not cross without losing the very will to thrive that HAS to be in place to motivate a successful regimen.

So what do I recommend? A lot of soul searching. Because once committed, the risk of resistance becomes very real if decisions are reversed. That should be scary. This is scary stuff.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline HIVworker

  • Member
  • Posts: 918
  • HIV researcher
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #71 on: June 08, 2006, 10:45:08 AM »
The other thing that bothers me in all of this is that doctors frequently claim that resistance to HIV medication even with 100% compliance is due to that person being infected with a "Highly mutating" strain of HIV. In the absence of data, this explanation is mere hand-waving. While it is a definite possibility, it is also possible that the particular drug combination that the person was on was defective for reasons of PK in that individual. Claiming the virus is "highly active" or "Aggressive" might lead to the person thinking that NO drug combination will work for them. In the absence of clear data that this is the case it seems to me a pretty unfair thing to claim. Why blame the virus when it could be the specific treatment that is at fault. While personal PK issues can not be predicted prior to giving any drug and therefore can not dictate therapy, to throw the hands in the air and claim the virus is aggressive because it didn't work seems a little short-sighted.

R
« Last Edit: June 08, 2006, 10:48:02 AM by HIVworker »
NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #72 on: June 08, 2006, 11:10:06 AM »
Quote
Without locking patients up and monitoring their adherence, we have only patient report combined with lab/primate study to base our percentages on. And that's close to conjecture, albeit learned conjecture.
JK, could you expound on what you mean by this?  Are you saying that the studies that try to explore adherence in relation to treatment success or failure are inaccurate?  Please clarify.  Thanks.

Offline heartforyou

  • Member
  • Posts: 1,105
  • I must be a survivor in many ways...
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #73 on: June 08, 2006, 07:07:39 PM »
HIV worker,

I will see my doctor in a couple of weeks.
I will try to remember and ask her about it.

Hermie
Diagnosed in 1987 and still kicking
Viread, Kivexa (Epzicom),Viramune once daily

Happiness is the freedom of breathing fresh air every day.

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #74 on: June 08, 2006, 07:24:45 PM »
<< Are you saying that the studies that try to explore adherence in relation to treatment success or failure are inaccurate?  Please clarify.  >>

I am sorry I did not expand on this. I was saying that patient report, in the absence of monitoring, is soft data. I realize that there are monitoring devices which can be affixed to pill bottles and trays, which could deliver information about when the  bottle was opened, etc. These studies carry far more weight with me than patient report alone.

However, I have yet to see the science behind a "90% success rate" if adherence is present. Could you possibly provide this data?

More to the point (well, HIVWorker's point really) what qualifies as success? Undetectable viral load? Patient quality of life? The absence of OIs? Rising CD4 count? Percentages?

I truly despise being in the position of board downer here. My vote is for a realistic look at the state of our medical art, and participation in that practice as a patient with all available  information, not only the convenient or happy facts.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline HIVworker

  • Member
  • Posts: 918
  • HIV researcher
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #75 on: June 08, 2006, 10:38:40 PM »
Hermie,

Please do. I just want to know whether they have any evidence that you have a highly mutatable strain.

JK

As ever you bring up a good point and one I am keen to get more data about. I mean keeping viral load down without mutations. I echo your point though. Current therapy, while better than nothing, is far from viable. If HIV medication was able to keep the viral load down in an acceptable manner, then this forum wouldn't have a whole section dealing with side effects. Clearly this is an area that urgently requires action. It is not surprising, perhaps, that there are so many side effects because for one there are so many drugs to take at the same time. There is a world of difference between keeping the virus at bay and improving quality of life. I would like to hear what other people think...

I would also love to hear more on what people DONT like about current therapy.

R
« Last Edit: June 08, 2006, 10:40:27 PM by HIVworker »
NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #76 on: June 09, 2006, 01:36:10 AM »
JK:

If you are asking about studies on adherence and “treatment success,” this study is one of the most commonly quoted studies that gave rise to the desirable 95% adherence rate.  The virologic failure was defined as VL>400.  In this study, even at the 95% adherence rate, virologic failure was still at 22%, but 80% of those with less than 80% adherence experienced virological failure at 6 months.  The point being emphasized in studies such as this is that as adherence declines (for whatever reason), virologic failure increases.  But this only addresses the relationship of adherence to virologic failure.  It does not provide a direct link to emergence of drug resistance or its quantification.   This review article discusses other aspects that come into play as far as emergence of resistance is concerned including potency of the regimen, adherence, tolerance, genetic and pharmacologic barriers to development of resistance, and transmission of resistant strains.

As to your other question as to what qualifies as success, I guess that will really depend on the individual, and would certainly be influenced by a lot of factors, including experience with drug treatment.  Here’s another article that explores factors that influence some long-termers’ decision-making on ART.

It’s probably prudent to not dismiss studies based on patient reports as “soft data” particularly if the conclusions being arrived at are pretty consistent.  If you do, you run the risk of creating a cloud of suspicion on the very data that you present when you try to make your case regarding HIV transmission risks because a lot of these studies are, after all, also based on patient self reports.

Gerry

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #77 on: June 09, 2006, 03:27:15 AM »
<<, If you do, you run the risk of creating a cloud of suspicion on the very data that you present when you try to make your case regarding HIV transmission risks because a lot of these studies are, after all, also based on patient self reports>>

For the record, I DO emphasize transmission data that relies upon more concrete information than post-infection patient reports. Moreover, the romero and other serodiscordant studies actualyl utlilize methodology which makes the common pitfalls of patient self-report work in favor of, not against, the collection of accurate data.

While I do not dismiss patient report studies entirely, I am constantly reminded that the plural of anecdote is not data. Patient report is notorious in it's unreliability. And when patient report flagrantly disputes other scientific methodology (e.g. laboratory study and primate/simian research) I am very skeptical, especially considering the controversial issues of sexuality and a virtually unheard-of required level of drug-regimen adherence.

There are three studies using serodiscordant couples I tend to use almost exclusively in order to asertain transmission rates, as they provide the hardest data. Say what you want about my scientific abilities, I am consistent.

The salient point of this thread, and my participation in it, is to emphasize that adherence is absolutely vital in order to achieve sccessful therapy. But in time, given the mutating quality of the virus and the body's long-term response to the drugs, it is estimated that many if not most first-line treatments will ultimately fail. Whether this happens in months, years, or decades seems to be the sticking point that scientists are attempting to asertain.

<< In this study, even at the 95% adherence rate, virologic failure was still at 22%, but 80% of those with less than 80% adherence experienced virological failure at 6 months.>>

Which was my point precisely. Not trying to scare ANYONE with this data, but it's important to know where we are, and are not, in the field of HIV research and medicine. We are staying alive for decades longer than anyone ever thought we would, thanks in large part to HAART. However, we only have perhaps fifteen year's worth of data to go by. And from the poignant and heartfelt postings made by (often dismissed or ignored) old-timers, these fifteen years have often come with a tremendous price in dignity, financial security, and even quality of life. These things should neither be dismissed nor ignored in favor of blind optimism. Such an approach, in my opinion, is not support. It is mutual deception and denial, and ultimately it casts out those who have the most experience and wisdom to offer newly diagnosed/newly treated people.






"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #78 on: June 09, 2006, 10:29:41 AM »
"The salient point of this thread, and my participation in it, is to emphasize that adherence is absolutely vital in order to achieve sccessful therapy."

This is something we can definitely agree on, and by "successful therapy" I'm assuming you mean maximum viral suppression

But in time, given the mutating quality of the virus and the body's long-term response to the drugs, it is estimated that many if not most first-line treatments will ultimately fail. Whether this happens in months, years, or decades seems to be the sticking point that scientists are attempting to asertain.

I don't think scientists have even ascertained that the first sentence of your statement here is true, especially in the subgroup of individuals who do not harbor resistant strains, who started HAART in the latter half of the last decade, who are able to tolerate the meds and who are able to follow your first statement above ("adherence is absolutely vital in order to achieve successful therapy")

And from the poignant and heartfelt postings made by (often dismissed or ignored) old-timers, these fifteen years have often come with a tremendous price in dignity, financial security, and even quality of life. These things should neither be dismissed nor ignored in favor of blind optimism.

Agreed.  And it is just as important not to dismiss the favorable results achieved by others with their treatment, including several long-termers, as just an illusion.  They are just as real as others' experiences.

HAART is not the ultimate answer to HIV, but its the only thing we've got at the moment for those who are lucky enough to have access to it.  And while we are trying to desperately wait for the next breakthrough, we need to make the most of what we've got.  That's all I'm saying.

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #79 on: June 09, 2006, 12:38:56 PM »
<<Agreed.  And it is just as important not to dismiss the favorable results achieved by others with their treatment, including several long-termers, as just an illusion.>>

I have not done this. Will not do this. Will not ever do this. And as I mentioned before, despise being put into the position of defending a point of view which even implies this.
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline jae

  • member
  • Posts: 1
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #80 on: June 15, 2006, 02:08:03 AM »
While it is certainly possible for resistance to occur, I think that it is far better to maintain 100% adherence (or at least as close as possible) and keep hope alive that the virus either doesn't develop resistance or that it at least takes while before it does. I have been on Sustiva and Combivir since Sept. of 2000 and have managed to keep my viral load non-detectable from the beginning. So far there is no sign of resistance, minimal side effects, and no liver damage from the toxic nature of the drugs.

Offline Optimistic

  • Member
  • Posts: 326
  • An Apple A Day Keeps The Doctors Away!
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #81 on: June 16, 2006, 02:47:19 PM »
Justin, steering clear of the meds because of potential side effects and eventual resistance is a little like not dating until you have planned the wedding. Nothing lasts forever, or works perfectly. And not everyone has the same experience.

The key is to stay alive until the next breakthrough. And then the next. and then the next.

I understand what you mean by surviving until the next breakthrough....which is why I am not against taking meds....just a lil afraid.

Hmm not dating until I have planned the wedding?!.....does it count that I have already planned the perfect wedding when I was a kid....but I am still not dating as of yet.   ;D 

Justin
12/06 (Atripla): cd4 - 260; cd% - 33%; vl - 169
1/07 (Atripla): cd4 - 267; cd% - 38.1%; vl - 132
4/07 (Atripla): cd4 - 373; cd% - 33.9%; vl - <50
7/07 (Atripla); cd4 - 287; cd% - 35.8%; vl - <50
9/07 (Atripla); cd4 - 356; cd% - 39.5%; vl - <50
12/07 (Atripla); cd4 - 517

Offline USNRET

  • Member
  • Posts: 19
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #82 on: June 16, 2006, 07:21:09 PM »
My doctors says that resistance happens when you don't adhere to your regimen.  Also a lot of people they see in the clinic meds are working fine, then get reinfected with another strain of HIV from continuing to have unprotected sex and then then drugs they currenty take don't seem to work for the new HIV strain they aquired.

Offline The Canuck

  • Member
  • Posts: 628
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #83 on: June 16, 2006, 07:26:02 PM »
Quote
My doctors says that resistance happens when you don't adhere to your regimen.

It's actually not the case. I wasn't resistant to any meds when I started my first regimen. In less than 8 months I became resistant to Ziagen ( abacavir ) and was 100% adherent...never missed a dose and all took in time.

Regards,

The Canuck

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #84 on: June 16, 2006, 07:28:49 PM »
Interesting. Because there are less than two dozen confirmed cases of reinfection on record, and scientists postulate that reinfection is most likely in the months directly after initial infection, before the dominant strain asserts itself. Perhaps all these cases were/are from the same clinic?

Insofar as adherence is concerned, it is vital for a successful regimen. But to postulate that resistance automatically equals a lack of adherence is a gross misinterpretation of the science and the epidemiology. It also stigmatizes a patient as non-compliant when there is NO proof of such.

I am continually shocked at how stupid doctors think we patients are. How often they "dumb down" information until it is essentially worthless, and certainly inaccurate. Or perhaps these doctors are not as well versed in the latest medical studies as they purport to be? I don't know, and really don't care much. In the end, its the uninformed patient (or the patient who trusts his healthcare provider without verification) who suffers.

Trust, but verify. The science, the truth, is out there in first tiered peer-reviewed scientific journals. The facts about resistance and reinfection and all sorts of other potential pitfalls which can beset HIV infected people are better and better understood every day. We as patients owe it to ourselves to do that research necessary to make important life decisions.

Even if it means ultimately changing incompetant or condescending doctors.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline USNRET

  • Member
  • Posts: 19
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #85 on: June 16, 2006, 07:33:53 PM »
That's funny the VA Medical Center and the Naval Medical Center both passed this information to me that that is one reason why they have drug failures.  I tend to listen to the doctors and specialist, I don't think that make things up.   That is my opinon but everyone can have there own. 

Offline The Canuck

  • Member
  • Posts: 628
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #86 on: June 16, 2006, 07:37:18 PM »
Well..I'm just a living proof your doctors are wrong.

The Canuck

Offline USNRET

  • Member
  • Posts: 19
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #87 on: June 16, 2006, 07:45:16 PM »
What do you mean by that Canuck.   I am not saying other factors can't play a part in why HIV Meds don't work, these are the two things you can do on your own to help try to make them work. 

Offline The Canuck

  • Member
  • Posts: 628
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #88 on: June 16, 2006, 07:52:39 PM »
This is very easy to understand :

#1 diagnosed and tested for resistance....results...no resistance to any meds.

#2 Started my combo and 100% adherent

#3 About 8 months later...showing sign of resistance..tested again and results were a high resistance to Ziagen ( abacavir )...treatment failed.

#4 I didn't have any sex with anyone during this period ( actually for the whole year after my diagnosis ) excepted with myself..no risk at all of reinfection ( if such thing can occur ).

The Canuck

Offline USNRET

  • Member
  • Posts: 19
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #89 on: June 16, 2006, 07:59:02 PM »
Again...beleive what you want...these are all opinons.  I never said that one cannot become resistant other than the two ways I have described.  Only that these are the issues they are dealing with at the Military and Veterans Infectious disease clinics.   I know everyone is not alike...people become resistant even when they do everything they can.   These are two things people can do to have peace of mind that they did there part...adherence and protected sex.  Enough said.  I'm done.

Offline The Canuck

  • Member
  • Posts: 628
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #90 on: June 16, 2006, 08:04:14 PM »
It's not a believing what I want...you stated
Quote
My doctors says that resistance happens when you don't adhere to your regimen.
and I gave you facts that resistance can occur when you adhere to your regimen, that's all. You statement sounded like you can't developped resistance when adhering to your regimen, and it's not my reality.

The Canuck

Offline USNRET

  • Member
  • Posts: 19
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #91 on: June 16, 2006, 08:12:05 PM »
Canuck I apologize if I typed something wrong or interpeted what you said wrong.  I do agree with what you said.

Offline The Canuck

  • Member
  • Posts: 628
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #92 on: June 16, 2006, 08:15:20 PM »
There's no need to apologize. This is simply a discussion and we haven't cursed at each others.  ;)

The Canuck

Offline Life

  • Member
  • Posts: 2,388
  • Member 2005
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #93 on: June 16, 2006, 08:42:02 PM »
Did it develop today?  Nope...  Kewl..  I get another day, sweet.. :)

Offline Matty the Damned

  • Member
  • Posts: 12,228
  • Ninja Please
Re: Can Resistance Still Occur Even With 100% Adherence?
« Reply #94 on: June 16, 2006, 09:01:42 PM »
There's no need to apologize. This is simply a discussion and we haven't cursed at each others.  ;)

The Canuck

Yup, by Living With standards, this thread is a complete group-hug. ;D

MtD

 


Terms of Membership for these forums
 

© 2014 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.