HIV Drug Resistance Not Patients' Fault
Best Patients Get Most Drug-Resistant HIV
Bad Virus, Good Patients
Bangsberg's team found that about half of the patients who took their HIV drugs exactly as they should had exactly the expected results. Their HIV levels got very low and stayed that way.
But the other half of the good patients didn't have quite such excellent results. Their HIV levels stayed low enough to protect them from disease -- but not low enough to keep the virus from slowly developing HIV drug resistance.
"Maybe their drug regimen is not potent enough, or maybe there are issues with how specific drugs work for specific patients," Bangsberg says. "Even with perfect adherence, half of our adherent patients have HIV that is incompletely suppressed. They have the most rapid evolution of resistance."
Bad Patients Still Worth Treating
It's sometimes argued that anti-HIV drugs shouldn't be offered to patients who won't take them as prescribed. That's a bunch of hooey, Bangsberg and Gross argue.
Both have published studies showing that doctors simply can't predict which patients will fail to follow doctors' orders. Now, they note, there's no compelling public health reason not to offer the drugs to anyone who wants them.
That's true, says Scott Holmberg, MD, senior epidemiologist at the CDC's National Center for HIV, STD, and TB Prevention.
"One often hears the reason you shouldn't give anti-HIV drugs to some groups of patients is that those who are only partially compliant are more likely to develop resistance," Holmberg tells WebMD. "This study may make people more reassured to start therapy with people who they think will not be adherent."
Gross says researchers should work on ways to improve adherence.
"The goal is to get patients to adhere to treatment as well as they possibly can," Gross says. "Yes, the best patients get more resistance. But they are not going to get as sick as those who adhere poorly and progress to AIDS. Let's work on getting people to adhere. If they develop resistance, so be it."
And while nobody wants to see HIV drug resistance develop, there's a silver lining. Many drug-resistant HIV strains are less deadly than other types of HIV, Gross notes.