HIV resistance – should we fear a super-bug?
July 9th, 2010
Many people looking into HIV Treatment for the first time are concerned about drug-resistant strains of HIV. It’s no wonder, with all the news out there about a “super bug”. It is true that HIV mutates and evolves very quickly, and inside a person’s body, it can be resistant to specific drugs that person is taking. But this is just one piece of the HIV drug resistance story – and maybe not the most useful piece for people who are newly diagnosed and wondering how they will respond to meds.
The thing about HIV’s rapid mutation is that it’s also seemingly random and completely lacking any quality control. In a person who is not taking antiretroviral treatments (ARVs), HIV produces billions of new copies of itself each day and every single one can be a little bit different from all the others. According to a recent article published in Relay Magazine, “the quality control process is so poor that every single possible change in the HIV can be produced within one or two days of infection”. But one variant doesn’t stand out among the others unless it has the advantage.
Imagine you have a bit of a mouse problem in your house, and the mice come in a whole range of colours. You buy a cat to chase the mice but the cat just can’t stomach blue mice. The blue mice end up surviving and thriving while all other colours are killed. The previously colourful mouse colony is now just blue. In the case of HIV, somebody who is not taking antiretroviral treatment will have a very colourful HIV infection. Enter the cats! Nowadays, in the rich world at least, when somebody starts taking ARVs, they’ll be taking a combination of drugs (called highly active antiretroviral therapy or HAART) that attack the HIV at different stages in its replication.
There are now more than 20 different ARVs available in six different classes that attack HIV in different ways and are combined to maximize effectiveness. Your doctor will help you decide when it’s time to switch up one medication for another. People who have been living with HIV and taking treatment for many years will have fewer options, but new drugs (and even new ways of attacking HIV) are being researched and developed all the time. Unfortunately, unlike our mouse and cat example, bringing in other drugs (a blue-mouse-eating cat?) cannot eliminate the HIV altogether. We do not have a cure for HIV; some HIV always remains in the body. Or, there’s always a mouse hole the cat can’t find. The goal of the ARVs is to keep the HIV from replicating, because more virus means a greater attack on your immune system, and because replicating means mutating, and mutating means resistance. It does feel like a bit of an uphill battle, but studies show that many people are successfully avoiding resistance.
The most important way to delay and prevent resistance is to follow your medication schedule precisely and consistently. Taking your meds on time, at the same time, and as directed, allows them to work at their maximum effectiveness, attacking the HIV in its replication and restricting its ability to mutate. While it continues to be hotly debated, it is advisable to continue practicing safer sex with other HIV positive partners so that you don’t risk reinfecting each other with resistant strains of HIV (or “sharing” resistance, so to speak). Staying away from street drugs is also important, as they make it very hard to follow a drug regimen precisely, as well as increasing the likelihood of sharing needles and having unprotected sex which can also lead to reinfection and increase resistance.
Like so many issues relating to HIV/AIDS, resistance is not black and white. We can’t even say for sure whether resistance is inevitable. But we have developed some amazing ways to avoid and work around it.
-Miriam
This blog represents the ideas of individual writers, and does not necessarily reflect any formal stance taken by Positive Women's Network.
This was posted on Friday, July 9th, 2010 at 10:00 am and is filed under Body Health, HIV Treatment . Feel free to respond, or trackback.
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