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Drug Resistance a Growing Problem for HIV-Infected Individuals
THURSDAY, Jan. 13 (HealthDayNews) -- In another sign that the glory days of AIDS treatment may be coming to an end, new research suggests that about one-quarter of all HIV patients have developed immunity to at least one powerful drug. Those who take their medications most of the time, but not always, seem to face the highest risk of drug immunity. But even those who only miss 10 percent to 20 percent of their doses are more likely to develop drug resistance, the study found. "This isn''t like horseshoes, where close is good enough. Close is probably a bad thing in terms of resistance," said P. Richard Harrigan, co-author of the study released Thursday and director of the British Columbia Center for Excellence in HIV Research Labs, in Vancouver, Canada. Harrigan discussed the research at a press briefing Thursday in New York City sponsored by the American Medical Association. The results also appear in the Feb. 1 issue of the Journal of Infectious Diseases. A new generation of AIDS drugs changed the face of the disease in the mid-1990s, drastically lowering levels of the virus in the bodies of infected individuals and allowing many patients to live more normal lives. But the treatments didn''t cure the disease, and they often cause side effects that make patients reluctant to take them. For the past several years, doctors have raised the alarm about drug resistance, warning that the medications will become less effective over time, perhaps once again dooming patients to the high fatality rates of the 1980s. In the new study, Harrigan and his colleagues looked at the medical and prescription records of 1,191 HIV patients from British Columbia who were treated with "triple therapy" -- a combination of three AIDS drugs that work in different ways. Eighty-four percent of the patients were male, and their average age was 37; they were followed for two and a half years, beginning in 1999. Perhaps due to side effects or forgetfulness, only about one-third of the patients in the study actually followed their prescribed drug regimens. Those who filled all or 95 percent of their prescriptions didn''t develop drug resistance. But immunity appeared most quickly in those who filled 80 percent of their prescriptions. Overall, "the worst place would be to take 70, 80, 90 percent of your prescriptions," Harrigan said. The patients were more likely to become immune to the drug lamivudine, known as 3TC; development of resistance took an average of 8.3 months, the study found. Scientists suspect that missing a few doses allows the AIDS virus to replicate and mutate, creating new forms that are immune to certain drugs. The virus never leaves the body and returns with a vengeance when drug treatment stops, Harrigan said. "Therapy is lifelong," he said. "If you take these therapies and go off them, in about a month, the amount of HIV in your bloodstream is right back where you started from." Drug resistance isn''t necessarily fatal. Patients who become immune to one medication are often able to find another one that still works. But side effects remain a potential threat when a patient tries a different medication. On the positive side, Harrigan said AIDS drugs are becoming easier to take, and that may help patients do a better job of keeping up with their regimens. Doctors are especially hopeful about new available medications that combine several AIDS drugs into one pill. It''s possible patients would develop immunity to several drugs at once if they miss doses, forcing them to take different drugs separately, said Dr. Kimberly Smith, an assistant professor of medicine and an AIDS specialist at Rush University Medical Center in Chicago. But the ease of taking all-in-one drugs should help patients follow their regiments properly and decrease the likelihood that they''ll develop resistance, she said. More information To learn more about HIV/AIDS, visit the U.S. Centers for Disease Control and Prevention.
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