What Factors Contribute to Resistance During Treatment?
If there's one "golden rule" of antiretroviral therapy, it is: the lower the viral load while on treatment, the less likely it is that the virus will continue reproducing and mutating. A powerful HIV regimen is the most effective way to keep the level of virus low—preferably "undetectable" (<50 copies/mL as measured by a sensitive viral load test)—and to delay additional mutations from occurring.
Unfortunately, there are a number of factors that can prevent an HIV drug regimen from being as powerful as it can be. These include:
Poor treatment adherence: In order for HIV drugs to work correctly, they must be taken exactly as prescribed. Skipping doses or not taking your medication correctly can cause the amount of an HIV drug to decrease in the bloodstream. If the drug level becomes too low, HIV can reproduce more freely and accumulate additional mutations.
There are a number of reasons why someone might struggle with treatment adherence, including side effects, a hectic schedule or forgetfulness. If you've been having difficulty adhering to your drug regimen, it's nothing to be embarrassed about—be sure to tell your doctor so that you can up with solutions, which might including simplifying your treatment.
For a more complete understanding of the importance of adherence, click on the following lesson link:
Poor absorption: Not only must HIV drugs be taken on schedule, they also need to be absorbed effectively into the bloodstream. A drug, or combination of drugs, that is not absorbed properly can result in levels in the bloodstream that are too low and, ultimately, allow HIV reproduction and the accumulation of drug-resistance mutations. Certain drugs have dietary requirements, which can affect absorption. People with HIV can also experience diarrhea and vomiting, which can cause HIV drugs to be expelled from the gut too quickly and affect absorption.
Varying pharmacokinetics: Pharmacokinetics is the scientific term used by researchers to mean how a drug is absorbed, distributed, broken down, and removed from the body. Interactions between drugs—including common HIV medications—can be a major problem in this regard. For example, if the NRTI Viread (tenofovir) is combined with the protease inhibitor Reyataz (atazanavir), blood levels of Reyataz can fall to dangerously low levels. This is why the protease inhibitor Norvir (ritonavir), which boosts Reyataz levels in the bloodstream, must be used if Viread is also prescribed.
There are many drug interactions like this. Be sure that your doctor knows all of the medications you are taking, including prescription drugs, over-the-counter remedies and nutritional supplements. And get a second opinion from Check My Meds, our personalized drug interactions checker.
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