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| Resistance happens |
| By Jim Montalto, News Editor |
| Published: 01/08/2007 |
The Infectious Diseases in Corrections Report ends 2006 with a particularly important piece about ART, also know to health care professionals as antiretroviral therapy. According to newsletter editor and article author, Dr. David Alain Wohl, in his introduction to December's main article Everything You Wanted To Know About HIV Drug Resistance But Were Afraid To Ask, while the combination of current ART regimens has increased the life expectancy of those infected with HIV by approximately 24 years, the therapy can be expensive, must be taken for several years, and can be complicated by chronic adverse side effects. Still, the drugs seem to be well tolerated, even though HIV continues to be one of the greatest challenges to the medical community because of its ability to rapidly replicate and produce. In corrections, HIV drug resistance is not uncommon, especially when offenders have intermittent exposure to ART. Therefore, Wohl explains, it is essential that those correctional health providers managing HIV infection understand ART resistance. To help, Wohl provides seven of the most pertinent questions and their accompanying in-depth answers. He discusses the commonality of drug resistance with a brief history of HIV therapies used and how resistance to them came about. He then summarizes saying, "the take-home lesson from this trial and other studies of resistance to current ART regimens is that the great majority of patients treated with ART will achieve virologic suppression. Of those who do experience virologic failure, a substantial proportion does not have drug resistance evident at the time of failure. For some of these patients, a total lack of adherence could explain this observation as the absence of drug removes the selective pressure applied by ART and permits non-resistant wild-type virus to rebound. In other cases, the presence of drug resistance appears to be influenced by the composition of the regimen, with resistance rarely detected when regimens contain a ritonavir-boosted PI." He goes on to explain how patients can avoid drug resistance, how often people can get infected with a drug resistant virus, the meaning of a "less fit" resistant virus, and the best way to manage patients who have developed resistance to many drugs and ART classes. Wohl also delves into the genotype argument that says there is no resistence to ART by discussing the validity of HIV drug resistance tests. He concludes with a summary of his questions and urges readers to understand that although ART resistance might be a reality, it does not have to be inevitable. "Potent therapies are now available in extremely convenient formulations and dosing schedules. Adherence remains a cornerstone of drug resistance prevention and correctional facilities have unique advantages in the monitoring and encouragement of treatment adherence. In addition, close surveillance of response to HIV therapy and quick action when viral load increases are detected can forestall further damage from evolving mutations. New drugs in existing classes that are already FDA approved and those expected to be shortly, hold the promise of a new chance for many patients who have developed HIV drug resistance. Wise use of these medications based on clinical trials data, patient history and detected and suspected ART resistance will increase the odds for treatment success." IDCR's Spotlight section discusses with Dr. Richard Wolitski ways to reduce HIV and STD transmission risk behaviors following prison release. Wolitski is Acting Deputy Director for Behavioral and Social Sciences in the Centers of Disease Control Division of HIV/AIDS Prevention, and the lead author of the START study, which looked at interventions to reduce HIV/STD risk behaviors among 522 young men being released from California, Mississippi, Rhode Island and Wisconsin prisons. For the full report visit the IDCR website. |
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