HAART fail when remain undetectable?

[Jackmydin]

Recently I have been thinking about this... Thought I could ask you guys for your opinion.

The main reason for HAART is control/reduce the virus and the main goal is to achieve undetectable. And when undetectable, 6 months of viral load test to oversee the treatment progress.

However, recently I have been wondering if its possible a person to develop drug resistance after remain undetectable. I know there are other factors for the treatment to fail, so let's assume a person who never miss a dose, living healthy lifestyle would ever fail HAART treatment even remain undetectable for years. And what could possibly contribute to that failure?

[Jim Allen]

 

Recently I have been thinking about this...

Why and, in what way are you thinking about this I wonder?

I ask because if its a worry/fear that you have besides curiosity, than I would say there are very few certainties in life. So I find worrying about rarities outside of our control or that in context may not apply to us, unproductive.

However, recently I have been wondering if its possible a person to develop drug resistance after remain undetectable. I know there are other factors for the treatment to fail, so let's assume a person who never miss a dose, living healthy lifestyle would ever fail HAART treatment even remain undetectable for years. And what could possibly contribute to that failure?

Your question is basically with perfect adherence can the treatment still fail after years of being effective and possibly lead to developing resistance or vise-versa? Yes, however remember that poor (sub-optimal) adherence is the main factor in cases and also (largely) within our control.

Pre-existing (missed/unchecked/low level) drug resistance to one or multiple drugs
Poor treatment adherence. (despite reporting adherence)
Underlying medical conditions/History
Underlying medical treatments (interactions)
Poor absorption
Older drugs effectiveness vs newer drugs, might be a factor in combination with the above.

We had a thread on this 2 years ago
https://forums.poz.com/index.php?topic=66234.msg726870#msg726870

[Jackmydin]

Hi Jim,

Thanks for the link provided. Well it's a bit of a concern as I plan to have a closer relationship with someone and fear that I could possibly infecting my partner during the 6 months time (viral load test every 6 months). What if during the 3rd month or 4th my viral load spiked and infected my partner during intercourse..

But I do understand your point of not to worry things which are out of our control and keep strong adherence with the drug. Sometimes I just couldnt help myself thinking the worst scenarios.

[Jim Allen]

So as I figured you are worrying about rarities that may not apply to you.

If you have good treatment adherence with modern meds and you are healthy otherwise than it is like wondering "what if" I fall down the stairs and break my neck this morning? In fact personally odds of me breaking my neck this morning are vastly greater than me developing treatment issues, as I live above a shop, strairs are crap and I have bad legs (Context).

Relax, I hope the relationship goes well and as long as the other person is aware and has made a choice that is their choice.  If they or you need additional reassurance than use condoms or they could take PrEP.

Jim

[Jackmydin]

Yea you are right. Jim.

Thanks. Your reply sort of correct my way of thinking. I shouldn't be worried of rarities, and better start focus on living a better quality lifestyle.

Lately has been really uneasy for me as I have been discussing of such matter with my parents. About having a partner in life etc. They are still "locked" on the old ways of how hiv is a death sentence and I shouldnt be thinking of having a lifetime partner. I tried to educate them how modern meds has become and I'm no longer a walking infections but it seems like a long road to go. they even doubt on where I gathered such info and how genuine it is, despite I told them its already approved by cdc 6 months or long of undetectable means I'm no risk of transmission!!

*sorry for the rant.

[CaveyUK]

It's a shame that so many people stay ignorant to medical advances and science but it's quite common.

That the ignorance comes from parents seems even worse. Your best bet will probably to provide them with trusted links for them to research themselves, and in the meantime, try not to get drawn into their own anxieties.

[harleymc]

Sometimes the 'what ifs' crowd my head, the six months between testing and yada yada…

But it's not as if any of the participants in the partner 1 or 2 trials, hptn 052 or the opposites attract trials were being tested monthly.  So I calm myself with the reassurance that I'm in with the good crowd, and that I don't blip.

It's also a nice calming influence on me that my fiancée is up with the medical science and trusts my pill taking to keep him safe.

[Jackmydin]

Absolutely. The random thoughts of "what if" is too stressing if one dwell too much on unnecessary worrying. Staying well adhered with my drug is my greatest responsibility to people around me.