Study Findings Showing Widespread Drug-Resistant HIV is ‘Wake-Up Call’ for HIV/AIDS Doctors, Patients
Study findings showing that at least half of all HIV-positive people on antiretroviral drug therapy have developed drug resistance is a "wake-up call" for health care professionals and AIDS advocates, Dr. Douglas Richman, who presented the findings yesterday at the American Society for Microbiology's annual meeting on infectious diseases, told the Washington Post (Brown, Washington Post, 12/19). According to the study, 64% of the 2,000 study participants receiving antiretroviral therapy experienced a rise in viral levels over time, indicating that they are receiving "less benefit" from their highly active antiretroviral therapy regimens than they were two or three years ago. Researchers found that 78% of the patients who exhibited rising viral levels also developed drug-resistant strains of HIV, most likely because of "[w]idespread misuse" of the medicines. Many doctors switch their patients' drug regimens "in a never-ending search for minimal side effects, ease of use and viral suppression," and this "chaotic use" of antiretrovirals has led to a rise in "mutant HIVs" that can resist the drugs. In addition, the study found that 20% of people who were newly infected with HIV and had not yet taken antiretrovirals were already carrying drug-resistant strains of the virus that they contracted from a sexual or intravenous drug use partner (Kaiser Daily HIV/AIDS Report, 12/18).
Implications for Treatment, Prevention
Gay white men who have access to health care were more likely to have developed drug-resistant virus, according to the study. Middle-class gay white men were among the first to use antiretroviral drugs, either singly or in combination, and researchers believe this earlier access may be the reason behind this group's greater drug resistance, as single drug use has been associated with higher drug resistance. "It's a wake-up call that we've created a lot of resistance with the use of our drugs, and that it's happened in a short period of time," Richman, who is with the VA San Diego Healthcare System, said. "We've seen this before with malaria and (tuberculosis). ... Some of it is due to the nature of the beast, but it also shows that we have to use our drugs more intelligently," he added (Washington Post, 12/19). Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, called the results "striking" and said they should serve as a "wake-up call to develop new drugs" (Sternberg, USA Today, 12/19). Richman agreed, but added that there also needs to be "more use of drug resistance testing to manage patients who have failed treatment and who have been recently infected" (Los Angeles Times, 12/19). With the current drugs proving less effective and new strains of HIV emerging, "[w]e could be right back where we were in 1984, when the virus was unstoppable," Larry Kessler, executive director of the Boston-based AIDS Action Committee, said, adding that a rise in drug resistance has been something that activists "really have been worrying about, dreading" (Mishra, Boston Globe, 12/19). In addition, the presence of resistant HIV strains in newly infected populations "underscores the importance of prevention," Dr. Ronald Valdiserri, deputy chief of sexually transmitted diseases at the CDC, said (Haney, AP/Las Vegas Sun, 12/18).