{"id":101,"date":"2023-01-01T12:00:37","date_gmt":"2023-01-01T12:00:37","guid":{"rendered":"http:\/\/moomango.co.uk\/ttfa\/?page_id=101"},"modified":"2023-01-20T11:34:26","modified_gmt":"2023-01-20T11:34:26","slug":"13-viral-lifecycle-drug-resistance-and-adherence","status":"publish","type":"page","link":"https:\/\/i-base.info\/ttfa\/section-2\/13-viral-lifecycle-drug-resistance-and-adherence\/","title":{"rendered":"2.13 Viral life cycle, drug resistance and adherence"},"content":{"rendered":"<h2>Viral life cycle: copies, mistakes and mutations<\/h2>\n<p><strong>When not on HIV treatment (ART), HIV produces billions of new copies every day. In doing this, HIV also makes very small mistakes. These are called mutations<\/strong>.<\/p>\n<p>Before taking ART, every possible single mutation is already being produced.<\/p>\n<ul class=\"expanded\">\n<li>These mutations are usually weaker than the original (wild-type) virus.<\/li>\n<li>The mutations don&#8217;t develop though because wild-type is stronger.<\/li>\n<li>Wild-type HIV and mutations compete \u2013 and the stronger virus wins.<\/li>\n<\/ul>\n<p><strong>But drug mutations on ART will be more fit. They can stop the drugs from working.\u00a0This is called drug resistance<\/strong>.<\/p>\n<ul class=\"expanded\">\n<li>With drug resistance, the\u00a0resistant HIV is <strong>stronger<\/strong>\u00a0than wild-type.<\/li>\n<li>Eventually, having high viral load on ART drives the resistant HIV to becomes the <strong>majority virus<\/strong>.<\/li>\n<li>Some mutations affect other drugs in the same class. This is called <strong>cross-resistance<\/strong>. For example, resistance to one NNRTI can stop other NNRTIs from working. Or resistance to one integrase inhibitor can mean other integrase inhibitors will no longer work.<\/li>\n<\/ul>\n<h2>Resistance, treatment and viral load<\/h2>\n<p><strong>Drug resistant mutations stop HIV drugs from working as well. Sometimes they stop working completely.<\/strong><\/p>\n<ul>\n<li>The higher your viral load on ART, the higher the risk of drug resistance.<\/li>\n<li>This is why getting viral load needs to be as low as possible, ideally below 50 copies\/mL.<\/li>\n<li>Drug resistance doesn&#8217;t develop when viral load is undetectable (&lt;50 copies\/mL).<\/li>\n<\/ul>\n<h2>Resistance and adherence are closely related<\/h2>\n<p><strong>Resistance develops when your drug levels are too low. This is why adherence is so important. <\/strong><\/p>\n<p><strong>Adherence means taking HIV drugs on time, in the right way, every day<\/strong>.<\/p>\n<p>Taking meds late or missing doses increases the risk\u00a0of drug\u00a0resistance. The drug levels become too low to control HIV.<\/p>\n<p>ART needs to be taken as prescribed to keep drug levels about a minimum level. This includes following advice to be taken with food or without food.<\/p>\n<p><strong>Drug interactions<\/strong> can also affect the levels of ARV drugs.<\/p>\n<ul>\n<li>HIV drugs\u00a0can interact with other HIV drugs.<\/li>\n<li>They can interact with some OI meds (especially for TB).<\/li>\n<li>They can interact with some recreational drugs.<\/li>\n<li>They can interact with complementary and herbal products.<\/li>\n<\/ul>\n<p>Always tell your doctor and pharmacist about any other medications or treatments that you are taking. This includes products that you buy without a prescription.<\/p>\n<h2>Drug levels and resistance<\/h2>\n<p><strong>Taking drugs at the exact same time keeps levels well above the level you need.<\/strong><\/p>\n<p>Each time you take a drug, the drug level increases to stay above this level.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-102\" src=\"https:\/\/i-base.info\/ttfa\/files\/2009\/06\/resistance_simple.gif\" alt=\"Regular doses keeps drug levels high enough avoid resistance\" width=\"450\" height=\"235\" \/><\/p>\n<p>If you are late with a dose, or miss dose, the drug levels fall. If they drop too low, drug resistance can develop.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-103\" src=\"https:\/\/i-base.info\/ttfa\/files\/2009\/06\/risk.gif\" alt=\"Missed dose = low drug levels = risk of resistance\" width=\"450\" height=\"180\" \/><\/p>\n<p>Missing or being late with one dose will still be okay.<\/p>\n<p>But if you often are late or forget, it makes it easier for drug resistance to develop.<\/p>\n<p><strong>Adherence is not about doing what your doctor says.<\/strong><\/p>\n<p><strong>Adherence is about you taking control of HIV. It is about always staying above the minimum levels. You want to do this 100% of the time when on ART.<\/strong><\/p>\n<h2>Further reading<\/h2>\n<p>i-Base\u00a0<a href=\"https:\/\/i-base.info\/ttfa\/hiv-and-drug-resistance\/\">online training course of drug resistance<\/a>.<\/p>\n<p>This is a learning resource for HIV advocates. It is section 9 of this manual and covers HIV and drug resistance in detail.<\/p>\n<p>Each module should take 30\u201360 minutes. It was published in 2011 and updated in 2014.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Viral life cycle: copies, mistakes and mutations When not on HIV treatment (ART), HIV produces billions of new copies every day. In doing this, HIV also makes very small mistakes. These are called mutations. Before taking ART, every possible single &hellip;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":76,"menu_order":11,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-101","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/pages\/101","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/comments?post=101"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/pages\/101\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/pages\/76"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/media?parent=101"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}