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Author Topic: Understanding Drug Resistance & Adherence: animated presentation  (Read 3264 times)

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Offline newt

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  • the one and original newt
Understanding Drug Resistance & Adherence: animated presentation
« on: November 17, 2006, 04:13:02 AM »
Promted by Iggy's thread on where to find info on drug mutations, I fished out this link to the John Hopkins' animated presentation that goes over the basics: how HIV infects CD4 cells, role of reverse transcriptase and protease, how drugs work, how drug levels affect resistance etc.

John Hopkins HIV Guide: Understanding Drug Resistance & Adherence (requires Flash player)

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

Offline poet

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  • Poet living and working in Central Maine
Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #1 on: November 17, 2006, 05:59:23 AM »
My usual thanks to you, Matt, for doing the work so that we can post here with a clear sense of the research.  Best, Win
Winthrop Smith has published three collections of poetry: Ghetto: From The First Five; The Weigh-In: Collected Poems; Skin Check: New York Poems.  The last was published in December 2006.  He has a work-in-progress underway titled Starting Positions.

Offline Bartro

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #2 on: November 17, 2006, 09:20:49 AM »
Excellent presentation.  Although I've read and been lectured on the topic this now makes it crystal clear.  Thank you very much.
Rusty

Offline Teresa

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #3 on: November 17, 2006, 10:30:18 AM »
Thank you newt!

I had hubby watch it. He got alot from it. Thanks again!

Hugs
Teresa
Hubby HIV+ 5/5/06
CD4:320
  %: 26.7
 VL: <20
Atripla (started it 8/24/06)
 

Offline racingmind

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #4 on: November 17, 2006, 11:12:11 AM »
Yeah, that is a good presentation...but I have a question:

The presentation stresses that the virus is constantly replicating and creating mutant strains without meds...

With the meds, it stops replicating and therefore can no longer create mutant strains that are likely to be drug resistant...

So, logically, it would seem that it is in a person's best interest to start antiretroviral therapy as soon as possible to prevent the creation of mutant strains by ceasing the viruses ability to replicate itself. 

Yet, the doctors seem to want to wait to start meds....this to me no longer makes sense since it seems that you have a lot to gain by stopping replication (regardless of VL or CD4 counts).

Will someone please explain to me why I should wait to go on meds?  I'm terribly confused after watching that presentation.

Thanks,
Dxx
Tested Negative: 5/06
Tested Positive: 9/06 
9/06: CD4: 442 (28%) VL: +100,000
10/06: CD4: 323 (25%) VL: 243,440
11/06: CD4: 405 (28%) VL: 124,324
12/06: CD4: 450 (29%) VL: 114,600
1/07: CD4: 440 (27%) VL: 75,286
3/07: CD4: 459 (30%) VL: 44,860
5/07: CD4: 353 (24%) VL: 50,852
7/07: CD4: 437 (29%) VL: 39,475
9/07: CD4: 237 (32%) VL: 372,774
10/07: CD4: 324 (27%) VL: 115,454 
Started Atripla: 10/07
11/07: CD4: 524 (?%) VL: Undetectable!
2/08: CD4: 653 (35%) VL: undetectable
5/08: CD4: 822 (40%) VL: undetectable
8/08: CD4: 626 (35%) VL: undetectable
12/08: CD4: 619 (36%) VL: undetectable
3/09: CD4: 802 (38%) VL: undetectable
7/09: CD4: 1027 (43%) VL: not tested
10/09: CD4: 1045 (43%) VL: undetectable

Offline pozguy75

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #5 on: November 17, 2006, 11:24:02 AM »
Newt, this is great stuff! Easy to understand and very informative! Thanks for posting!!
Dx 2005
ATRIPLA

Offline pozguy75

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #6 on: November 17, 2006, 11:28:01 AM »
Will someone please explain to me why I should wait to go on meds?  I'm terribly confused after watching that presentation.

Thanks,
Dxx

Hey Dxx,

One main reason doctors want to wait, is because, startig meds too soon can actually do more harm than good. The best defense we have is our own immune system. Think of the meds as a supplement to our immune system. If you have high CD4 count, then the body is doing what it needs to do by keeping the little bugger at bay, however if your CD4 count reaches the threshold of 350 or fewer, then it's time to bring in the reinforcements.

Also, by adding the meds too soon, could actually lead to resistence that much sooner...so, follow your doctor's advice and wait...let your body do the work it's supposed to...

I hope this helps!

J
Dx 2005
ATRIPLA

Offline newt

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  • the one and original newt
Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #7 on: November 17, 2006, 12:18:20 PM »
Dxx

What J said above

Plus, most of the mutations are defective - the mutant virus is often broken, weaker, feeble, sterile, don't work proper etc, and cant get a foothold against the fitter, non-mutated types.  Your HIV infection starts off as a mix, with several different varieties struggling for control, and usually one strain, hopefully the non-resistant, easy-to-treat "wild type", wins this contest and ends up being the majority of the HIV in your body.

- matt
« Last Edit: November 17, 2006, 12:21:22 PM by newt »
"The object is to be a well patient, not a good patient"

Offline Eldon

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #8 on: November 17, 2006, 04:20:07 PM »
Hey Newt,


Thank you for the information that you have provided to each and every one of us.



Make the BEST of each Day!

Offline Longislander

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #9 on: November 17, 2006, 06:13:11 PM »
Thank you Newt.
infected 10/05 diagnosed 12-05
2/06   379/57000                    6/07 372/30500 25%   4/09 640/U/32% 
5/06   ?? /37000                     8/07 491/55000/24%    9/09 913/U/39%
8/06   349/9500 25%              11/07 515/68000/24     2/10 845/U/38%
9/06   507/16,000 30% !          2/08  516/116k/22%    7/10 906/80/39%
12/06 398/29000 26%             Start Atripla 3/08
3/07   402/80,000 29%            4/08  485/undet!/27
4/07   507/35,000 25%            7/08 625/UD/34%
                                                 11/08 684/U/36%

Offline randym431

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  • Posts: 1,115
Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #10 on: November 18, 2006, 07:05:41 AM »
Its a simple and good illustration on something most all of us already know, but always worth the reminder. As with most drugs, not keeping the desired high level in the blood will, or can cause the drug to become useless. With antibiotics its the same story. Thats why so many doctors are told not to prescribe antibiotics as openly as they use to. And how even antibiotics used in raising farm animals has caused antibiotic failure in humans simply because we eat meat containing the antibiotics used in raising farm animals and then we become resistant to these antibiotics. In the medical world its pretty scary to doctors seeing higher and higher antibiotic resistance.

So it breaks down to very simple but life saving guide. Do like your mother says, take your pills. Donít skip or play around. And thats why they put that label on the pill bottle, "take all medication until finished, even if you feel better before".

However, from watching this presentation I wonder why  fusion inhibitors are not also part of the cocktail. Like a one-two and three punch instead of the one-two punch we take now? And I would think somehow measuring drug levels in the blood during a 24 hour period would better customize treatment since people have different abilities to retain drug levels. I would think a testing of that would be done at some point on everyone taking meds, to make sure the drug levels are not falling off too fast, even if you take your meds daily and on time.

Offline Bartro

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #11 on: November 18, 2006, 09:25:45 AM »
If I'm not mistaken the only fusion inhibitor is Fuzeon which must be injected under the skin twice daily.  From what I've read it's only used when other treatments fail.
Rusty

Offline thunter34

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  • His name is Carl.
Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #12 on: November 18, 2006, 09:54:03 AM »
Thank you, Matt- for taking the time to research this and post it. 
AIDS isn't for sissies.

Offline allopathicholistic

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #13 on: November 25, 2006, 04:45:58 PM »
thanks!

and bump (knowledge is power)

Offline blondbeauty

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  • Posts: 1,784
Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #14 on: November 25, 2006, 08:46:53 PM »
Thanks Matt. Excellent presentation. I am one of the crazy people that start treatment "early"... :-\But I am happy I did.  ;D
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.

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  • Joined Dec-2003 Living positive, since 1985.
Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #15 on: November 25, 2006, 10:48:14 PM »
Hey Matt,


Thanks for bringing this subject matter and this presentation back up.


Very informative ---Excellant presentation !!!



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 MSPspud

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  • Joined Mar 2005 - Formerly UofMurbs
Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #16 on: November 28, 2006, 02:41:22 PM »
<bump>

because I find myself thinking about this presentation each and every time I take my meds. 
« Last Edit: November 28, 2006, 02:48:13 PM by MSPspud »

Offline kentb

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #17 on: November 28, 2006, 03:39:31 PM »

Matt, thanks for taking time to post this as well as many other important issues.  You have a unique knack for comprehending and helping others understand how the virus and meds. work.  The fact that you take so much time to educate others is really caring and compassionate of you!

Thanks,

Kent in Atlanta

Offline newt

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  • the one and original newt
Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #18 on: December 02, 2006, 06:20:22 AM »
B U M P (cos someone asked where to fnd it ...) - matt
"The object is to be a well patient, not a good patient"

Offline gvolts5

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #19 on: December 02, 2006, 06:41:52 AM »
Much thanks Mattster. 

John

Offline jntmax39

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #20 on: December 03, 2006, 03:06:59 AM »
MATT
THANK YOU SO MUCH FOR THAT LINK I UNDERSTAND NOW WHAT IS HAPPENING TO MY BODY. THE NARRATION HELPED ME TO UNDERSTAND BETTER

Offline alterman

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #21 on: December 06, 2006, 02:17:49 AM »
Thanks for the good stuff

Offline newt

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  • the one and original newt
Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #22 on: January 21, 2007, 04:41:40 AM »
I bump again
"The object is to be a well patient, not a good patient"

Offline Teresa

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Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #23 on: January 21, 2007, 02:23:38 PM »
I will bump it this time.

Thanks newt.
Hubby HIV+ 5/5/06
CD4:320
  %: 26.7
 VL: <20
Atripla (started it 8/24/06)
 

Offline poet

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  • Poet living and working in Central Maine
Re: Understanding Drug Resistance & Adherence: animated presentation
« Reply #24 on: January 21, 2007, 04:14:02 PM »
Dxx, another way of thinking of it is that the virus in you is constantly replicating in response, if you are NOT taking meds, to basically nothing: there is no wall yet that it needs to figure out how to work around.  For some people, their strain or strains of virus are just not that effective so while they try to take over things, their bodys' own immune system (as previously noted) is sufficient to work against it using cd4's and cd8's.  Once you start meds, and the reason for genotyping, figuring out ahead of taking them which ones will work given the strain(s) of virus in you, your virus is working against the only resources we have: antiretrovirals.  So your immune system alone can't handle the virus and if, worst case scenario, the meds. you are taking can't handle the virus, you have a big problem.  Which is why adherence is also critical, allowing no holiday, no open window through which enough of the virus can get through to overcome or to work around the meds.

Or think of water rising, how you start by plugging the dam and building the level of the dam higher, hoping that you can build it high enough that the water can't crest above it.  If the dam breaks, if the virus is able to break through the meds., you are flooded.  Win
Winthrop Smith has published three collections of poetry: Ghetto: From The First Five; The Weigh-In: Collected Poems; Skin Check: New York Poems.  The last was published in December 2006.  He has a work-in-progress underway titled Starting Positions.

 


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