Question

Will most people develop resistance to HIV treatment?

21 May 2008. Related: All topics, Living with HIV long-term, Resistance.

Is this true that after a number of years most people develop resistance to hiv treatment?

Answer

Answer: Simon Collins

No, hopefully not. Recent studies suggest that once your viral load is undetectable for more than 6 months, as long as you continue taking your meds, you have a less than 5% chance of your viral load rebounding each year. Resistance only develops under certain circumstances.

Firstly, you need to be taking treatment.

Secondly, you need to have ‘ongoing viral replication’ which is a medical way of saying that your viral load is still detectable. Once you start treatment, viral load should come down to undetectable (less than 50 copies/mL) within the first few months, and certainly by 6 months. Resistance doesn’t seem to develop when your viral load is below 50 copies/mL, and the quicker you get there, the less chance that you will develop resistance.

Thirdly, resistance will develop if you regularly miss or are late with your meds. This is because the drug levels fall below the minimum level to control the virus. When the virus starts reproducing again when you have low drug levels, you can develop to those drugs and to other similar drugs in the same class.

See this section on resistance, from the i-Base Introduction to Combination Therapy.

More detailed info on what to do if your viral load remains detectable, or rebounds, and on different aspects of resistance, and resistance tests in included in the i-Base Guide to Changing Treatment.
This guide also includes information about avoiding resistance in the future, including on how to pick meds for subsequent combinations.