Number of Newly Diagnosed Drug-Resistant HIV Cases More Than Tripled From 1995 to 2000
The number of people newly infected with a strain of HIV that is already resistant to at least one antiretroviral drug more than tripled between 1995 and 2000, according to a study published in today's issue of the New England Journal of Medicine, the Boston Globe reports. Susan Little of the University of California-San Diego and colleagues collected blood samples from 377 newly infected patients at 10 clinics in North America between 1995 and 2000. The researchers found that between 1995 and 1998, 3.4% of the patients they tested had a strain of HIV that was already resistant to at least one drug. By 2000, the frequency had risen to 12.4% (Smith, Boston Globe, 8/8). The overall frequency of multidrug resistance rose from 1.1% to 6.2% over the same time period and was most commonly found in men who have sex with men (Reuters/Washington Times, 8/8). According to the researchers, the figures represent a "conservative" estimate because they used the most "stringent" standards when defining drug resistance. Under more relaxed guidelines, up to 20% of newly infected patients may have drug-resistant HIV, they said (Boston Globe, 8/8).
Not Cause for Alarm
In an accompanying editorial, Martin Hirsch of Massachusetts General Hospital warns against overreacting to the study, saying its findings were "cause for concern but not alarm." He writes, "Although the study found that the prevalence of resistance increased significantly ... the overall prevalence of high-level multidrug resistance remained low." Drug resistance may make it more difficult for physicians to determine a proper treatment regimen, but once that regimen is found, treatment will generally be successful, he said, noting that available medicines were able to suppress the virus within 24 hours in every drug-resistant patient studied except one (Reuters/Washington Times, 8/8).
To assist in determining the correct course of therapy, Hirsch, as well as the study's authors, recommends that doctors test patients for drug resistance before initiating antiretroviral therapy. Although such tests are costly -- ranging in price from $300 to $1,000 -- they will eventually save money, as physicians will be able to eliminate ineffective drug options earlier. However, Dr. Margaret Fischl, an AIDS researcher at the University of Miami, said that screening every patient for resistance before initiating therapy would "add an enormous amount of expense at a time when funds are becoming short." To further combat resistance, Little and colleagues also recommend that doctors discuss the importance of drug compliance with their patients and offer assistance in adhering to their treatment regimens. Stressing safe sex practices among people on therapy is also important, Dr. Daniel Kuritzkes, director of AIDS research at Brigham and Women's Hospital in Boston, said (Boston Globe, 8/8).
NPR's "All Things Considered" yesterday featured a discussion about drug resistance among people with HIV with Little and Dr. Roger Pomerantz of Thomas Jefferson University. The full segment is available online in RealAudio (Silberner, "All Things Considered," NPR, 8/7).