Resistance to HIV medicines

The human immunodeficiency virus (HIV) changes (mutates) often. Sometimes these changes make the virus resistant to a particular medicine or class of medicines, which means the medicine is no longer effective against the virus. When this happens, the medicine no longer controls virus growth (replication) or protects the immune system.

If you start taking antiretroviral medicines early in the course of your infection, before your CD4+ cell counts have dropped and before your viral load has increased, you may "cycle through" all the available medicines. In this case, you may exhaust all the available medicines and have no options left when your viral load and CD4+ counts are at their worst.

Resistance testing is done to determine whether resistance has caused treatment to fail and to identify antiretroviral medicines that can be used to treat the infection. There are many reasons that treatment fails, such as:

• The virus is initially resistant to one or more antiretroviral medicines, or the virus mutates and stops responding to the medicines.
• There is a change in the way your body absorbs a medicine.
• There are interactions between two or more medicines that you are taking.
• You have not taken your medicine as prescribed.

Two tests are available to detect resistance to medicines used to treat HIV infections:

• Genotyping assays detect medicine resistance mutations in the viral genes. It takes 1 to 2 weeks to get the results.
• Phenotyping assays measure the ability of viruses to grow in cells with various concentrations of antiretroviral medicines. It takes 2 to 3 weeks to get the results.

Both of these tests are done on a sample of blood taken from a vein. These tests may not be accurate if the resistant virus is less than 20% of the circulating virus.

You may be tested for resistance when:

• You develop symptoms of HIV infection. The symptoms may be similar to an upper respiratory tract infection, the flu, or another viral illness.
• Your viral load has not decreased by at least one-half after 4 weeks of therapy.
• Your viral load has not decreased to a undetectable level within 4 to 6 months of beginning treatment. An undetectable level is defined as less than 50 copies/mL (by bDNA or RT-PCR test method).
• Your viral load is detectable after having been at an undetectable level.

If resistance has occurred, your doctor may need to change your antiretroviral medicines.