Important note: Information in this article was accurate in 2001. The state of the art may have changed since the publication date.
Newsday - December 18, 2001
Laurie Garrett, Staff Writer
Most striking, researchers said, is the demographic breakdown of drug resistance. Contrary to forecasts made in 1996 when combination drug therapy was introduced, it is not the poor and IV drug users who have the highest rates of resistance because of failure to properly take the drugs. Rather, it is white, gay, fully insured, highly educated men who carry the most highly drug-resistant viruses.
A national survey, conducted by RAND Corp. of Santa Monica and the University of California in San Diego of some 2,000 HIV patients, found that 64 percent are now getting less benefit from their drug cocktails than they were two or three years ago, as measured by rising levels of viruses in their bloodstreams. The purpose of Highly Active Antiretroviral Therapy, or HAART, is to lower the numbers of viruses in a patient's blood to below the limits of laboratory detection. Once viruses get past the HAART defense and surge into the bloodstream, patients have to switch to different drug combinations to keep virus levels low.
Since HAART was introduced in 1996, many patients - most, according to the new study - have switched so many times, they now receive less than optimal benefits from any anti-HIV combinations.
Among those who have such rising HIV blood levels, 78 percent have drug-resistant HIV. Even newly infected individuals, who have not taken the treatment cocktails, are showing astonishing levels of drug resistance - one out of five carry resistant viruses, acquired from their sexual or drug-use partners.
This means that by the most conservative possible reckoning of the data, "half of the people under care in the United States right now have resistant virus. It's quite frightening," senior researcher Dr. Doug Richman of UCSD said in an interview. Richman will present the findings today at the annual Interscience Conference on Antibacterial Agents and Chemotherapy meeting in Chicago.
"What is not politically correct to say in public is that both providers and patients are using these drugs suboptimally," Richman said. Both the well-educated patients and their doctors closely follow research news and trends in HAART treatment. They change their treatment plans constantly, in a never-ending search for minimal side effects, ease of use and viral suppression. With each switch of drug cocktails, the patients increase the likelihood of pushing forth mutant HIVs that can resist the drugs.
Richman fears this continued pattern of chaotic use of anti-HIV drugs means "we'll end up recapitulating the antibiotic story," referring to the problem of antibiotic-resistant bacteria.
HIV mutates more rapidly than bacteria, and because the HAART drugs are not curative, they must be taken forever. Both factors hasten the pace of emergence of viral resistance. And, "the incentives for the pharmaceutical industry to develop drugs against resistant HIV virus may not be there the way it is for antibiotics," Richman said, because the size of the HIV-positive population in wealthy nations is small.
This begs the question of just how much longer the HAART miracle that rescued AIDS patients from their death beds in 1996 will last. Roy Anderson, a mathematical modeler at Oxford University, recently calculated that each switch of medication, and each interruption in HAART therapy, has a cumulative effect. If those patients pass their highly drug-resistant viruses onto sexual partners, the pace of resistance society-wide accelerates markedly.
011218
ND011201
Copyright © 2001 - Newsday. All rights reserved. All pages of newsday.com are copyright © Newsday, Inc. Other parties may also own rights to portions of newsday.com content. No portion of newsday.com content may be published, broadcast or distributed, directly or indirectly, in any medium without Newsday's prior written consent. Newsday, Inc. will not be held liable for any delays, inaccuracies, errors or omissions in any content on newsday.com. http://www.newsday.com.
AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted funding from Broadway Cares/Equity Fights AIDS, Elton John AIDS Foundation, the National Library of Medicine, Pacific Life Foundation and donations from users like you.
Always watch for outdated information. This article first appeared in 2001. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1980, 2001. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .