Wednesday, October 19, 2005

Multi-Drug Resistant HIV

After watching an alarming episode of Law & Order: SVU last night, I was a wee bit disconcerted to see a similar alarm raised in Dr. Jeffrey Laurence's article in Medscape (registration required) concerning multi-drug resistant HIV. Turns out, Dr. Laurence wasn't writing about the scary "superbug" hyped on one of my favorite TV shows (it was one documented case, guys!!!), but about the very real problem of drug resistance, its causes and effects. While Dr. Laurence supports his own alarm with some disturbing reports of increasingly risky behaviors in the "age of HAART," his conclusions make good sense:

One group of investigators concluded, "While the prospects for maintaining viral suppression in people starting [antiretroviral therapy] remain good over the first 5 to 10 years, the longer-term prospects for continued viral suppression may increasingly depend on development of new antiretroviral drugs."[4] They are right.

But we also need to increase prevention education and maintenance. In addition, strategies to conserve treatment options, including delaying HAART until the CD4+ cell count predicts an unacceptable risk of opportunistic infections and malignancy, selecting regimens that preserve recourse to active drugs in case of treatment failure, individualizing regimens to account for the convenience of patients and their susceptibility to certain side effects, use of therapeutic drug monitoring, and design of clinical trials to assess the level of virologic failure that must trigger a change in HAART, should be considered.[12]

They got one thing right on SVU last night: Meth is death.

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