Does everybody get resistance?
My CD4 count is just above 550 and I’m thinking about starting treatment.
My question is, if I start treatment, and make sure I adhere every day – what are the chances of developing drug resistance?
I’m worried that I will start treatment but after five or ten years, no matter how religiously I stick to it, I will still have to change treatment to something that may be harder to take, or have stronger or nastier side effects.
Is this the case? Or is it possible I can stick to the same treatment indefinitely?
Thanks for your question as it is important to take drug resistance seriously.
Luckily, if your viral load becomes undetectable (below 50 copies/mL) and you are good with adherence, then resistance is very unlikely.
When the viral load is this below 50 copies/mL, drug resistance is very rare, and nearly always related to poor adherence and missing doses.
Many people have been on some of the same drugs for over ten years without getting drug resistance. In this case, the only reason to change treatment is when newer medications have other advantages (fewer doses or reduced side effects).
In the UK, your HIV doctor should give you a resistance test before starting ART. Unfortunately this isn’t available in all countries. This test can tell you if your strain of HIV already has drug resistance.
After starting ART, viral load usually undetectable within three months. Once your viral load has been undetectable for more than six months, the chance of your viral load rebounding each year is less than 1 in 20 (5%). This depends on your taking your meds as prescribed.
More detailed information on what to do if your viral load remains detectable or rebounds, how to avoid resistance in the future and different aspects of resistance can be found in the i-Base Guide to Changing Treatment and Drug Resistance.
For more information on starting treatment you might want to read the i-Base guide ‘Introduction to ART’
Good luck with starting your treatment and do let us know how you get on.
This answer was updated in January 2016 from a question first posted in June 2010.