POZ Community Forums
Meds, Mind, Body & Benefits => Research News & Studies => Topic started by: buginme2 on March 23, 2011, 01:17:46 am
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http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2011/03/13/bloomberg1376-LHPT9W07SXKX01-6NLHS2MMBPB2I1OSLRHQSGK3RK.DTL
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THis article implies that drug resistance will develop in the long run. Has anyone experienced this? I have only been recently dx in November 2010 and have had the fortunate experience of tolerating Atripla and having it work for me enabling me to be undetectable. If I take the medicine religiously on time 100% of the time will I need to change regimens in a few years. I am so fearful of te medicine all of a sudden stop working. Can anyone reassure me please!!!!!
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What this article says about resistance is mistaken. Resistance does not just "develop." If the virus is suppressed and the person is adherent resistance will not develop.
There are many other threads on here where this has been discussed and ample evidence has been presented, IOW, don't take my word for it.
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What this article says about resistance is mistaken. Resistance does not just "develop." If the virus is suppressed and the person is adherent resistance will not develop.
There are many other threads on here where this has been discussed and ample evidence has been presented, IOW, don't take my word for it.
So as long as I take my Atripla for example, My VL stays UD, have my CD4 count stay as high as possible and I adhere to my meds 365 days a year (366 in a leap year of course), then the chances of me developing resistance is almost impossible?
Or is it that at some point down the road, no matter what my adherence is, resistance will eventually develop? That's what I'm scared of because I've heard mixed answers...
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Actually the "safe zone" in terms of medication adherence is 95%, not 100% (once you've been UD for several months that is)
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Thats all great but it misses the point of the article. The article doesnt speak about an individuals propensity to develop resistance. Its talking about resistance as a whole. Resistance does occur in a percentage of people. I just read another article that said people who switch regimins due to side effects had a greater chance of developing resistance. So resistance will occur in some percentage of people every year. Resistance virus can also be spread so those newly infected can already be resistant to one or more classes of drugs. The point of the article is the drug pipeline is slowing down. So yes. Down the road it could limit options.
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No, actually the article is more nuanced than that but unless you have a larger contextualized picture of HIV treatment over the past 15 years you're not going to get it. I will try to explain, and will inject my own personal story in parts to illustrate.
After the introduction of protease inhibitors in late 1995 which brought us into triple drug therapy/HAART treatment there were still patients (and a substantial amount) who, no matter that they had 95-100% adherence, still developed resistance issues. The cause for this was two-fold, being either due to substandard treatment previous to that year (i.e. mono or dual therapy) or substandard initial protease medication that was rushed to market (i.e. saquinavir). So in my case I developed multiple class resistance 1) to NRTI's used in the early 90's and 2) the entire class of protease inhibitors due to saquinavir. However, because modern viral load tests didn't come on line for another year or two after HAART, and further because geno-pheno test didn't come on line until 5 years later, treatment decisions were stabs in the dark by physicians.
With that context in mind drug companies started to develop new generations of drugs in existing classes, as well as make entirely new classes, to keep people like me alive. However, of course, that took time and they didn't begin to arrive until Fuzeon was FDA approved in 2003. This drug had to be injected twice daily so it wasn't obviously ideal, so really it wasn't until Prezista was approved in late 2006 (keep in mind that was an entire decade after HAART had arrived) that a new drug, in an existing class (PI) arrived that was specifically beneficial to someone with existing resistance issues in that class. After that date several other meds also targeted this group of patients (Isentress, Intelence, etc.) So my point was that from 1996 until 2006 there was a lot of activity in HIV medication development, but you must see it in the context that it was targeting patients with resistance issues caused by the scenario I laid out. People who began treatment after the development of HAART that didn't encounter what, for example, I did generally should not have developed resistance issues. Further these new post-2006 weren't developed for these other patients specifically, but as we now see patients new to treatment now benefit from their development, as drugs like Prezista and Isentress are now routine for treatment naive patients.
So the larger picture is that once these new meds came out patients like me finally "caught up" to other patients and suppressed their viral load (again, as an example, though I began taking HIV treatment in mid-1993 I didn't get a fully suppressed viral load reading until mid-2006). If you were a patient like me who, even once these new meds arrived in 2006, wasn't able to suppress your viral load you are, most likely, in the grave in 2011.
Now on to the article, what they're saying is that in light of all of this, in general most HIV patients (read: in industrial countries) now have access to a drug regimen that fully suppresses viral load (exceptions now only include those patients that are not able to adhere at a rate of 95% target goal) so there's less profit incentive to develop new novel therapies, the exception being formulating new one-pill-a-day pills that would compete directly with the largest product Atripla -- and this we see in upcoming two Gilead one-a-day pills which should be approved late this year or early next year. The "pipeline" has shrunk, but the positive news is that it's shrunk because all of these new medications since 2006 have been so utterly and exceptionally successful. As a result the FDA has raised the bar in terms of what is needed for new drug approval, as stated on page 2 of the article. This also decreases the profit incentive for a drug company.
The relevant passage from the article is then "If we are complacent, resistance will start to spread against the key components of our therapies," Hammer said in an interview. "We need to be ready for that because we won't be able to catch up after it happens." But what he's saying isn't that resistance just "happens" or will happen to those with 95% adherence, but that there will always be a sector of patients that develop resistance because they don't adhere at that level, meaning there will always be a need for new meds. But what he doesn't state is what projected numbers for such patients actually are, or that until there's a profit incentive (read: larger pool of "new" drug resistant patients) there won't be an expanded pipeline of drugs in development.
Now that I've typed all of that I'm sure it probably won't makes sense to many of you, but whatever. If my writing isn't clear on any point please let me know.
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It makes perfect sense and very well stated.
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Good, it's rare that I type out six paragraphs in any thread ;D
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Thanks for taking the time to explain that.
I think many of us have that fear of developing resistance in the back of our minds. I feel like, to a small degree, it never really goes away.
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I feel like, to a small degree, it never really goes away.
I don't think you should indulge yourself at all in that for two reasons. 1) it's just not going to happen with that 95% aderence threshold. 2) even if it did happen you'd simply switch to another regimen, of which there are so many more options these days.
You'd have to have a series of treatment failures to exhaust any available alternatives, plus the two new regimen options from Gilead that are shortly forthcoming. Please relax your brain on this issue. The biggest challenge for most people having HIV is controlling unnecessary anxiety about things happening that are not going to happen in all likelihood.
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I'm far more concerned about funding and access to medicines drying up.
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Thanks for typing that out, Miss P. I also found it really helpful.
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I'm far more concerned about funding and access to medicines drying up.
Absolutely. Good point. Part of me hates that HIV meds cost $1800 or more a month, the other part of me welcomes it since that is one F'ing big motivation to create new treatments. Pharmaceuticals don't spend millions developing a new drug out of the goodness of their hearts. But people are being dropped left and right from ADAP. I wonder if they understand that by having people go untreated only leads to an increase in the spread of HIV which in the end creates an even bigger financial burden??
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I wonder if they understand that by having people go untreated only leads to an increase in the spread of HIV which in the end creates an even bigger financial burden??
That would be asking too much I think; it implies having common sense... LOL
But seriously. I haven't started medication yet. I have my very first appointment April 5 to get my blood drawn. And I'm frightened that I will have to start medication sooner rather than later since all this stuff I keep hearing about ADAP being basically bankrupt. I don't have any insurance so, I'd hate to start HAART and then not be able to continue it down the road.
Dan
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I'd say it depends which state you are in. If you were in Florida, I'd have serious reservations. Other states aren't doing that bad. Research it before you need it. Make sure you qualify, etc.
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I'd say it depends which state you are in. If you were in Florida, I'd have serious reservations. Other states aren't doing that bad. Research it before you need it. Make sure you qualify, etc.
LOL
I'm in Florida :-\
Dan
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There i go putting my foot in my mouth again. I don't live in Florida so I have no first hand knowledge. I have read some posting's here about the situation in Florida and ADAP. People being put on waiting lists and transitioned to Welstiva? I'm sure others can speak more about that.
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Don't worry about that. I've been aware of the situation here in Florida, that's why I've been on edge about finding out my numbers later in April.
I've brought this issue up with several people at the HIV support center I go to, and even though they acknowledge that ADAP is in a clusterf*ck right now, that if I were to need meds, they'd make sure I got them. (They say they'd make a deal directly with the pharma co's to get the meds or something).
I don't know if they are being matter of fact, or if they just say that so people don't freak out. I've heard of some people actually not having access because of lapses in coverage, so who knows.
Dan
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Actually the "safe zone" in terms of medication adherence is 95%, not 100% (once you've been UD for several months that is)
Okay cool. But I will still aim for 100% (Which I have done so far). I don't think I can even miss more than 1 pills in a year. Maybe on my birthday or something I wouldnt take it lol.
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I almost blew it tonight! This is the first time I fell asleep w/o taking my Atripla pretty much at the same time every night during the last year. I took some xanex earlier and fell asleep w/o taking it at the normal time and just got my dose in me shortly after 1:15 this morning.
This thread came to mind when I woke up and bolted to the pill bottle to count those little suckers. I believe I got it in me just in time to remain at my 100% adherence status... 6 hours late though. That was close.
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This is what my doc told me about Atripla. "It is one of those forgiving drugs.. if you forget to take it you have 12 hours to do so" He stressed 100% adherence but forgave if you missed 1 or 2 a year.
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DanMo,
Have you contacted Hope and Help in Orlando. They are very helpful.
http://www.hopeandhelp.org/
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This is what my doc told me about Atripla. "It is one of those forgiving drugs.. if you forget to take it you have 12 hours to do so" He stressed 100% adherence but forgave if you missed 1 or 2 a year.
Yea, I was just so good about being within that 3 hour window that I freaked a bit! I got back to sleep and had a dream about Larry Hagman (I Dream of Genie) showing his cock on network TV. Hmmmmmmm wonder where my mind has been lately??? People have been much later than 6 hours taking it w/o any negative impact.
Miss P's post in this thread was so timely (for me). I hope all newbies (like me) get a chance to read it.
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DanMo,
Have you contacted Hope and Help in Orlando. They are very helpful.
http://www.hopeandhelp.org/
Thanks bman for the info, I haven't heard of them. Right now I'm getting help from Miracle of Love.
Dan