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Confusing article about resistance to HIV meds

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Hellraiser:

--- Quote from: mecch on August 13, 2013, 11:00:03 PM ---What research supports this???  I've never heard of such a thing. I think you are flat out wrong, in fact.

--- End quote ---

Same, You don't develop resistance randomly.  When you miss doses resistance develops.

jkinatl2:

--- Quote from: life2 on August 13, 2013, 09:37:23 PM ---I didn't see anything wrong with the article.  Mutations still occur even when we are adherent to our meds and have an undetectable viral load.  Most mutations are not resistant to our meds and effectively killed off.  Eventually one of those mutations wins the resistance lottery. 

Viral load is akin to the number of lottery tickets HIV has and the length of time we are infected represents the number of lottery drawings.  HAART just reduces the number of those resistance lottery tickets out there. 

--- End quote ---

Citations, please. Because in my 20 plus years of dealing with HIV/AIDS I haven't ever heard documentation to this (fairly widespread) assertion/myth.

geobee:
My doc says if I stay adherent I'll stay UD and resistance won't happen. 

The virus isn't allowed to replicate, so it can't screw up it's reproduction / mutate.  She says I can probably stay on my meds (Reyataz, Truvada, Norvir) for the rest of my life (I'm 50). 

life2:

--- Quote ---What research supports this???  I've never heard of such a thing. I think you are flat out wrong, in fact.
--- End quote ---

Sorry, I didn't think this was that controversial.  Here's one to start...

http://jac.oxfordjournals.org/content/64/suppl_1/i37.long


--- Quote ---Modern combination therapy is highly effective in reducing the replication of the virus to undetectable levels and in maintaining that suppression. The rate of therapy failure (as determined by viral load becoming detectable) is ∼5% per year.1 Nevertheless, since therapy is required lifelong, a significant minority of patients are likely to develop resistance to at least one class of drugs and it has been shown that the likelihood of failure is greater with second-line therapy.
--- End quote ---



--- Quote ---Same, You don't develop resistance randomly.  When you miss doses resistance develops.
--- End quote ---

Resistance arises from mutations and mutations occur randomly all the time in every species.  The one we're most familiar with is cancer. 

HAART greatly reduces the viral load in our blood but doesn't eliminate it and if it's still there mutations still occur.  The presence of a mutation doesn't equate to resistance.  My initial genotype tests indicated 5 different genetic variants but I have no resistance to any drugs.

I'm not trying to trivialize this but the the discussion around resistance is largely statistical.  Remaining adherent to successful HAART greatly reduces viral load and in the presence of HAART fewer mutations are occurring reducing the odds of one of these being resistant. 






mecch:
Precisely. Future projections are statistical.
Nevertheless, since therapy is required lifelong, a significant minority of patients are likely to develop resistance to at least one class of drugs and it has been shown that the likelihood of failure is greater with second-line therapy.

There is NO PROOF of this statement. Its conjecture.

Also, who is included in the study subjects?

What is "a significant minority"?

I see HIV specialist doctors, who are also research professors.  The word is, there is no fear of resistance being an issue, these days, if you are adherent.

Bug posted the article because he wondered, it seems to be sloppy, or worse, fear mongering..  Old fears....  Old data.  Old experience....

I think you are fear mongering, too.  You haven't supported your words, below, whatsoever.

Eventually one of those mutations wins the resistance lottery.  Viral load is akin to the number of lottery tickets HIV has and the length of time we are infected represents the number of lottery drawings.  HAART just reduces the number of those resistance lottery tickets out there.

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