How Many Medications Do Hiv Patients Take – Here’s a detailed look at HIV drug resistance, what it is and how to test for it. Also, get advice from your HIV doctor about prevention and what to do if you develop HIV resistance.
If you are living with HIV, you may have heard of HIV drug resistance. Perhaps your HIV provider has even discussed HIV drug resistance testing with you. But what is drug resistance? How common is it, should you be concerned about it, and more importantly – what can you do to prevent it?
How Many Medications Do Hiv Patients Take
HIV drug resistance is a problem because it means that the type of HIV you are infected with is “resistant,” or not affected by a certain type of HIV medication. Drug resistance can limit the treatment options that are effective for a person.
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In this article, we briefly describe HIV drug resistance, what it is, and how to test for it. We also get advice from HIV doctors about prevention and what to do if you develop HIV drug resistance.
HIV drugs work by stopping the virus from replicating (replicating itself). When a particular strain of HIV can replicate itself, even in the presence of specific antiretroviral drugs, we say it is “drug resistant.”
Resistance to HIV drugs is not a common situation. People living with HIV may have one or more resistance mutations that make them less sensitive to one or more antiretroviral drugs. For example, if people have protease mutations, their HIV may become resistant to protease inhibitors, meaning that protease inhibitors such as darunavir (Prezista) may not work for them. People with reverse transcriptase mutations can develop resistance to drugs such as the nucleoside reverse transcriptase inhibitor emtricitabine/TDF (Truvada).
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Because antiretroviral drugs of the same “class” (such as two different types of NNRTIs) block HIV replication in the same way, if the virus becomes resistant to one drug in that class, it may become partially or partially resistant to all drugs. resistance is in that class. For example, people who develop HIV resistance to Prezista may also develop resistance to atazanavir (Reyataz), because both are protease inhibitors.
“If someone develops or even acquires drug-resistant HIV, usually no major harm is done. There are usually other drugs that are effective,” said David Alain Wohl, MD, a professor in the Department of Infectious Diseases at the University of North Carolina at the University of North Carolina. Chapel Hill. “But with greater resistance, there are fewer second chances and less flexibility. This means we may have to use drugs that are more difficult to take or have more side effects. In rare but not uncommon cases, people There is no choice.”
“HIV treatment today is very effective. HIV drug resistance, once common, has become very rare in patients taking modern drugs, even among those who are poorly compliant,” International Association of AIDS Providers Benjamin Young, MD, senior vice president and chief medical officer of Care (IAPAC), told BETA.
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“Resistance is particularly rare among people taking first-line HIV integrase inhibitors. This was particularly true for dolutegravir (Tivicay), where only one case of treatment-emergent resistance was reported during initial treatment. With today’s treatment options, with effective and well-tolerated second-line options, it easier to deal with drug-resistant viruses,” Young said.
Acquired HIV drug resistance can occur when a person is infected with HIV that replicates (replicates itself) while taking certain antiretroviral drugs. HIV can mutate “around” the drug. This will cause HIV to develop resistance to drugs that are now ineffective. Acquired HIV drug resistance develops in more than 70-80% of virological failures in most studies. (Remember, once a person’s virus is suppressed, these resistance mutations are no longer a problem.)
Although acquired resistance can develop if a person does not adhere well to their HIV drug treatment, sometimes the drugs themselves or a combination of a person’s body’s response to the drugs can also lead to resistance. Even if you maintain perfect compliance, you may experience malabsorption. This means that these drugs are not easily absorbed by your body and do not stop HIV from replicating, which can lead to drug resistance.
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Sometimes drugs with poor pharmacokinetics can lead to drug resistance. This means that the drugs are not effective because they cannot move through your body efficiently and sufficiently.
Transmitted HIV drug resistance occurs when a previously untreated HIV-infected person becomes infected with an HIV strain that is already resistant to one or more HIV drugs. As the name suggests, transmission of drug resistance occurs when an HIV strain with a drug-resistant mutation is passed from an HIV-infected person to an HIV-negative person. Estimates of the prevalence of transmitted drug resistance among people living with HIV in the United States range from 12% to 24%.
Pretreatment HIV drug resistance can occur even before treatment begins. This can happen if a person has been exposed to HIV drugs while living with HIV. For example, if a woman is taking drugs to prevent mother-to-child transmission of HIV, or a person is on pre-exposure prophylaxis (PrEP) and the person becomes infected with HIV, there is a theoretical possibility that the person could develop drug resistance.
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Resistance mutations rarely develop in people taking PrEP (remember, if HIV infection is prevented, there is no risk of resistance). A review of PrEP studies using the drug tenofovir disoproxil fumarate (TDF) found that TDF or FTC resistance mutations developed in 0.1% of about 9,000 people taking PrEP. (Most people in these studies who were HIV-infected and had a resistance mutation were already HIV-positive when they started PrEP and therefore should not have started PrEP.)
People living with HIV can prevent drug resistance by continuing treatment and taking their medications. With current HIV treatment regimens, “adherence” usually means taking the pill once a day. Proper adherence may also include taking the medication at a specific time of day, and with or without food, or on an empty stomach.
“We need to ensure that people who start treatment continue to receive effective treatment to prevent the emergence of HIV drug resistance,” said Gottfried Hirnschall, MD, MPH, Director of the HIV Division and Global Hepatitis Program at WHO.
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“The best thing people living with HIV can do to prevent drug resistance is to take their medications every day,” Wohl reiterated to BETA.
“The drugs we have now to control HIV work really well and are usually taken once a day. Plus, almost everyone tolerates them,” Wohl said.
In general, if you forget to take your medicine, take it as soon as you realize you missed it. However, if it is almost time for your next dose, wait until the next dose and continue with your normal routine. Most importantly, do not take a double dose, you cannot make up for a missed dose this way. While it’s important to take your HIV medications every day, you probably won’t develop resistance just because you miss a dose.
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Wohl explained that people often miss ARV doses because events in their lives cause confusion or prevent them from taking their medication. This is not because HIV antiretroviral pills are harder to take than other pills, or because they cause more side effects.
“Be honest with [your] provider and tell them how often and why you miss doses. Seeking help with compliance can earn your trust and allow [your] provider to find ways to help. Pill kits, set cell phone reminders and asking family or friends to help are examples of interventions that can support medication use,” Wohl said.
Your supplier is here to help you and wants to see you perform well. If you have any questions about a medication, it’s best to discuss it with your provider immediately. If you feel uncomfortable with your current medication regimen, your provider can work with you to find a more appropriate medication.
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Providers may also offer drugs that are less likely to cause drug-resistant HIV, Wohl said. “For some treatment regimens, the virus has to do more tricks to mutate so that it is less susceptible to the drug. These can be used on people who may be [less compatible] with the drug,” Wohl said.
Genotypic tests look for resistance mutations in genes associated with the virus. Most genotype testing involves looking at the reverse transcriptase (RT), protease (PR), and integrase (IN) genes for mutations known to be associated with drug resistance.
Because these genes are necessary for HIV to take over cells and replicate, it is the same genes that another class of drugs work to prevent HIV from replicating. This is why, for example, two of these drugs are called protease inhibitors and integrase inhibitors because they inhibit protease and integrase genes.
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