Treatment Resistance
The goal of HAART is to reduce the amount of HIV your blood. The treatment should stop you from becoming ill for many years. Sometimes, HAART works without any major problems or setback, but sometimes there can be problems. HAART have not been around for a very long time. Despite, on-going research and development, there are certain problems and issues associated with HAART. Here you can find some information about the issues you might face when on HAART.
Drug Resistance
HAART slows down the reproduction of HIV in the body. But the drugs cannot stop the reproduction of HIV completely, and so some HIV is able to survive despite on-going treatment.
HIV reproduces itself very quickly and when reproducing often makes slight mistakes. So each new generation, or new strain, of HIV differs slightly from before. These tiny differences in the structure of HIV are called mutations. Some of the mutations occur in the parts of HIV, which are targeted by the drugs.
So although you have some HIV that continues to be affected by the drugs, you have other strains of HIV that are not affected by the drugs as effectively as before. This is called drug resistant, and it enables HIV to reproduce without being affected by the drugs.
When someone has drug resistance, the amount of HIV rises and the risk of a person becoming ill increases. Drug resistance is one of the main reasons why HAART can fail. If resistance to current drugs is developed, this usually means that the drug regime needs to be changed.
Avoiding Resistance
There are certain things that can be done to minimize the risk of developing drug resistance
Cross Resistance
If HIV is resistant to a particular drug, it will sometimes be resistant to similar drugs in the same group. This is called cross-resistance and it means that some drugs from the same group might not work for you even though if you have used it before.
For example, if you develop resistance to one drug of the non-nucleoside (NNRTI) group, there is a risk that the other drugs in the non-nucleoside (NNRTI) group might not be effective for you.
Cross-resistance is a particular problem and limit treatment options available for people. In Malaysia, we do not have specific resistance testing to determine which particular drugs we are resistant to.
Changing Treatment
There are 2 main reasons why drug combination sometimes needs to be changed.
Firstly, if a person develops resistance to the drugs, in which the drugs fail to work and slow down the reproduction of HIV in the body. An increased level of viral load is sign of failing treatment.
Secondly, when the drugs often cause side effects. Sometimes these side effects are so strong and intolerable that the combination has to change.
Salvage Therapy
The combination drugs work at its best when used the first time. This is one of the reasons why treatment change has to be considered carefully and whether a change is really necessary. The combination drugs other than the first combination is called salvage therapy. It is also referred to as second line, third line or rescue therapy.
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Always consult your doctor first before stopping or changing combination |
*Info courtesy of Malaysian AIDS Council (MAC)