PHYSICIAN VOICES

4 Ways to Prevent HIV Drug Resistance

Untreated Human immunodeficiency virus (HIV) replicates extremely rapidly and, in the process, destroys your protective CD4 T cells. The goal of HIV treatment is to stop HIV replication and keep the virus in a dormant stage – and this is accomplished by taking the right combination of HIV medications every day. However, if given the opportunity, HIV will re-awaken and try to escape the treatment, which can happen when medications are taken improperly. Just a few missed doses may be enough for the virus to begin replicating at a high level again – and during this period of increased viral replication, the virus can create new permanent mutations. Some of these mutations might allow the virus to become resistant to your medications. Once drug-resistant mutations develop, that specific Antiretroviral Therapy (ART) regimen will not be effective against your virus ever again. Here are the four top ways to prevent HIV drug resistance.

The single most important way to prevent drug resistance is to take your medication every day as prescribed. When HIV multiplies, the virus can mutate into drug-resistant variations. Not only should you take your medications every day to keep the virus under control, but also to keep the virus from becoming resistant to your treatment. Once one antiretroviral regimen becomes ineffective, that specific treatment will never be successful again in controlling your HIV.  If there is any reason whatsoever that you cannot take your pill each day -- whether you are experiencing side effects, cannot afford the treatment, or if you find yourself forgetting to take your pills each day -- talk to your doctor right away. Most of the time there is a way to fix problems related to side effects or medication access, but there is no way to undo HIV drug resistance once it happens.

It’s extremely important to see your doctor on a regular basis. During these visits, your doctor will ask if you are taking your medications every day and tolerating them well. In addition, he or she will take a blood sample to make sure your HIV is under control. If your viral load - the amount of viral particles in one drop of your blood - has increased, or has become detectable when it was previously undetectable, that’s a tell-tale sign that your medication may not be working as effectively as it once was. If you are missing doses of your medication, tell your doctor so you can talk about ways to improve compliance and help prevent your virus from developing drug-resistant mutations. Typically, my patients will come in for testing every 3-6 months so we can monitor their levels and make sure they are doing okay with their medications.

If another doctor you are seeing prescribes a new medication for you, or changes the dose of a medication you are already on, make sure to tell your HIV provider about the change. Drug interactions impairing the effectiveness of your HIV medications are generally uncommon, but they do happen. Other medications could affect your HIV therapy, increase your risk for infection, or cause side effects to occur. Above all, make sure you are communicating with all of your doctors so that they can all effectively help manage your health.

If you do find out that your virus has developed resistance, you and your doctor should be aware of the risk of cross resistance when choosing a new medication. If your virus is resistant to a drug from a certain class of antiretrovirals, there’s a chance it will be resistant to other drugs within the same class.