Washington Blade - December 28, 2001
Kara Fox

AIDS experts say the findings are not new, since drug-resistant strains of the virus have been documented previously, but the findings show how widespread they have become in the last few years since combination antiretroviral drug treatments have become the mainstay in HIV care.

The findings were released and presented Dec. 18 at the Interscience Conference on Antimicrobial Agents & Chemotherapy in Chicago, sponsored by the American Society of Microbiology.

"This is the first comprehensive study to show just how prevalent drug resistance has become in the U.S., and underscores the need for physicians and patients to understand both the magnitude of resistance problem and the therapeutic approaches available to address it," Dr. Douglas D. Richman said in a news release about the study.

"Drug resistance testing should become a standard part of care," said Richman, a physician at the Veteran's Administration San Diego Healthcare System and a professor at the University of California at San Diego. "Physicians can use the valuable information provided by drug resistance testing to decide if and when treatment interventions are appropriate and to help patients avoid treatment failure."

Richman and colleagues tested blood samples taken in 1999 from 1,647 HIV-infected men and women living in 33 states, 30 cities and 50 rural areas, whose care was provided by 58 major hospitals or organizations and 200 small clinics or individual practitioners.

"They reflect almost 209,000 people and about 130,000 who have detectable [levels of virus in the blood]," Richman told Reuters.

Of those tested, 37 percent had no detectable HIV in their blood -- evidence that combination drug therapy had stopped the virus from replicating. That group harbored virtually no resistant virus.

However, 63 percent had detectable virus, including those people who were currently on or had previously taken antiretroviral therapy and those who had never been treated.

Of those with detectable virus, 78 percent carried a strain of virus resistant to at least one drug. While HIV in 87 percent of subjects taking antiretroviral therapy exhibited some drug resistance, virus in 41 percent of patients not receiving therapy also showed signs of drug resistance.

Overall, 49 percent of people in the survey carried a strain of resistant virus.

"Thus, drug resistant virus may exist in patients who have not started therapy or who have discontinued prior therapy," the study states. "This finding may have significant implications not only for previously treated patients, but also for newly infected individuals, who increasingly are infected with drug resistant strains of the virus."

Donald Abrams, a professor at the University of California at San Francisco, assistant director of AIDS Programs at San Francisco General, and a former president of the Gay & Lesbian Medical Association, said he didn't think it was wise to "promulgate" the findings of the study.

"We've known all along that the virus has existed and that people give it to others," Abrams said. "It is unclear whether [the people with the strain] need resistance testing. Whether [the findings are] clinically relevant or not is to be seen."

Abrams said it is important to point out to those living with HIV who may not be under treatment that there is a drug treatment out there that can work.

"Rest assured, we can find a successful treatment," he said. "I don't think people are destined to fail their treatment."

Abrams said he has seen drug resistance in his patients in San Francisco, but not at the increased rates shown in the study. He emphasized that it is important for people to practice safer sex so as to not give the drug-resistant strain to someone else.

Abrams added that he does not use drug-resistance testing in his patients before prescribing a drug regimen.

Antigone Hodgins, deputy executive director for policy and community development for the National Association for People With AIDS, said the findings were "scary" and said it shows that more education is needed so HIV-positive people do not go off their drugs.

"You have to be 95 percent inherent so you don't get resistant," said Hodgins, who is a woman living with HIV. "These studies are saying that this kind of education is needed."

NAPWA conducts training within the HIV community.

"HIV meds are not the silver bullet," she said. "This is something we have seen coming for awhile and now it's coming out in studies. ... Resistance can happen and it is happening."

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