Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date. Hi. I have several questions:
1) How come HIV infected people can develop resistance against Indinavir when they are only treated with Zidovudine?
2) How come people develop resistance quicker when treated with Zidovudine than with Indinavir?
3) When patients recieve combination therapy, how come they are more likely to develop resistance against Indinavir than against Zidovudine?
Really do hope you can help
Thank you!
Trevor Hawkins, M. D.
Associate Clinical Professor, Dept. Family Practice, University New Mexico
Medical Director, Southwest CARE Center, Santa Fe, NM
Answer to Question 1: The virus selects the mutations it needs to survive in the presence of drugs (see Darwin !!). If there is no pressure from Indinavir on the virus to select mutations that give it survival advantage in the presence of Indinavir, then those mutations will not appear. The only ways someone not on Indinavir could have Indinavir mutations are:
a) they took Indinavir in the past.Answer to Question 2: Both drugs have a fairly high barrier to resistance and the virus needs several mutations before it can become resistant to either drug. The time to resistance depends on many factors; if taken as single drug therapy which is most definitely NOT recommended, resistance will develop rapidly to any drug and probably a little quicker to AZT than to Indinavir.
Answer to Question 3: If someone were to take their Indinavir fairly regularly but only take their AZT occasionally, then the virus would select mutations more quickly to the Indinavir as that would be it's survival priority.
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