In San Francisco, 42% of all HIV infections will be with drug-resistant strains by 2005, suggests a UCLA/UCSF study published in September’s Nature Medicine. The researchers’ model, which has been used with considerable accuracy for other infectious diseases for more than 10 years, examines the growth of HIV resistance present in the community from the introduction of the current therapies in 1996 (0%) to 1999 (28.5%). Last year, 8%-9% of all new infections were resistant, and projecting forward, they conclude that almost half of local HIV-infected people will have significantly resistant strains in only four years. This study doesn’t speak directly to Austin, but the same phenomenon is happening here: The specific numbers just aren’t known.
When the treatments don’t fully suppress HIV, the virus mutates into versions that the drugs can no longer successfully control. This is usually a result of patients not taking their meds with the near-perfect “adherence” required. Alternatively, resistant HIV also can be passed from one person to another through unprotected sexual intercourse or shared needles. If someone’s virus is sufficiently resistant to enough of the drugs, there is less effective treatment (or none at all) for that individual, and he/she may move on to AIDS and death. New drugs, including two coming to market in the next year or so, may help to suppress resistant strains, but in time, resistance will develop against them as well.
Lots of people — young people and gay men, in particular — have adopted the risky notion that they don’t really need to play safely: If they become HIV-infected, they’ll just take the “drug cocktail” and everything will be OK. Yet again, we are shown how dangerous an idea that is.
This article appears in October 19 • 2001.