5 ms·

#What -- In several geographically distant third world countries HIV is becoming antiretroviral resistant in ~10% of cases. #Why -- No one is _really_ sure. T

by tim58 7y ago

#What -- In several geographically distant third world countries HIV is becoming antiretroviral resistant in ~10% of cases. #Why -- No one is _really_ sure. The most popular hypothesis is that it happens when people go on and off the medicine. Why would people do this? Shame, access, and some mothers that went on only during pregnancy. WHO recommended a pregnancy only treatment until ~2015. #Impact -- These resistant breeds can spread, presumably just like the other varieties. The people with it have a much worse prognosis than those without. #PrEP -- All the other parent comments talk about it. Sure, it should be used more frequently. It's a bit of a pipe dream to see it used in the 3rd world.

vsef 7y ago
Well, to be more clear on the #what: These are strains resistant specifically to efavirenz and nevirapine. Both drugs are members of the same class of anti-retrovirals, NNRTIs, which aren't prescribed together, they are two alternatives of the same type of drug and are used in combination with other drug classes. None of the people have resistance to anti-retrovirals in general, they have resistance to a particular class which is no longer recommended in the US (as a first treatment) but is still a go-to in Africa. There are multiple other drug classes that can be put together for effective treatment. In the US, Efavirenz (brand name Sustiva) used to be one of the first-line recommendations, but has been replaced by other drugs with fewer side effects and higher barriers to resistance. Importantly, no currently recommended starting regimens contain a member of the NNRTI class. All 4 of the current US recommended regimens now contain an integrase inhibitor (Dolutegravir, Bictegravir, or Raltegravir) https://aidsinfo.nih.gov/guidelines/brief-html/1/adult-and-adolescent-arv/11/what-to-start https://aidsinfo.nih.gov/guidelines/brief-html/1/adult-and-a... The integrase inhibitors have exceptionally few side effects and are also very high barrier to resistance. Dolutegravir which is mentioned at the end of the article is especially good in this regard, to the point that it is the only drug currently used in an only 2 drug (vs 3 drug) combination therapy. The main thing that needs to happen is for these areas to transition off of these particular NNRTIs.
dtornabene 7y ago
What purpose does the phrase "geographically distant" serve here? Seriously, why include that? Because, for one thing, while this site was started by an american, in america, its absolutely read all over the world, and two, HIV rates are highest in these "geographically distant third world countries". This is a really strange thing to post.
- roel_v 7y ago
  It meant (to me) that there are several 'pockets' of this happening simultaneously, it's not some local 'strain' or 'outbreak'. I thought it was a crucial thing to add, for nuance. Not sure why you're so agitated over this.
  - mantap 7y ago
    With the advent of air travel most of these geographically distant places are less than 24 hours away.
    - roel_v 7y ago
      ... That can still make them distant? Is Australia less 'distant' from Europe now that it takes 24 hours instead of 6 weeks to get there? In some senses, yes, but not in the sense that the GP used 'distant' (i.e., as a objective word for 'not adjacent').
      - deleted 7y ago
        [deleted]
      - deleted 7y ago
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      - dtornabene 7y ago
        and then it loses all meaning, because a pathogen that can travels within people who travel on planes is a pathogen unconstrained by geography. It was a very odd, and frankly, telling turn of phrase.

by tim58 7y ago

vsef 7y ago

Well, to be more clear on the #what: These are strains resistant specifically to efavirenz and nevirapine. Both drugs are members of the same class of anti-retrovirals, NNRTIs, which aren't prescribed together, they are two alternatives of the same type of drug and are used in combination with other drug classes. None of the people have resistance to anti-retrovirals in general, they have resistance to a particular class which is no longer recommended in the US (as a first treatment) but is still a go-to in Africa. There are multiple other drug classes that can be put together for effective treatment. In the US, Efavirenz (brand name Sustiva) used to be one of the first-line recommendations, but has been replaced by other drugs with fewer side effects and higher barriers to resistance. Importantly, no currently recommended starting regimens contain a member of the NNRTI class. All 4 of the current US recommended regimens now contain an integrase inhibitor (Dolutegravir, Bictegravir, or Raltegravir) https://aidsinfo.nih.gov/guidelines/brief-html/1/adult-and-adolescent-arv/11/what-to-start https://aidsinfo.nih.gov/guidelines/brief-html/1/adult-and-a... The integrase inhibitors have exceptionally few side effects and are also very high barrier to resistance. Dolutegravir which is mentioned at the end of the article is especially good in this regard, to the point that it is the only drug currently used in an only 2 drug (vs 3 drug) combination therapy. The main thing that needs to happen is for these areas to transition off of these particular NNRTIs.

dtornabene 7y ago

What purpose does the phrase "geographically distant" serve here? Seriously, why include that? Because, for one thing, while this site was started by an american, in america, its absolutely read all over the world, and two, HIV rates are highest in these "geographically distant third world countries". This is a really strange thing to post.

roel_v 7y ago
It meant (to me) that there are several 'pockets' of this happening simultaneously, it's not some local 'strain' or 'outbreak'. I thought it was a crucial thing to add, for nuance. Not sure why you're so agitated over this.
- mantap 7y ago
  With the advent of air travel most of these geographically distant places are less than 24 hours away.
  - roel_v 7y ago
    ... That can still make them distant? Is Australia less 'distant' from Europe now that it takes 24 hours instead of 6 weeks to get there? In some senses, yes, but not in the sense that the GP used 'distant' (i.e., as a objective word for 'not adjacent').
    - deleted 7y ago
      [deleted]
    - deleted 7y ago
      [deleted]
    - dtornabene 7y ago
      and then it loses all meaning, because a pathogen that can travels within people who travel on planes is a pathogen unconstrained by geography. It was a very odd, and frankly, telling turn of phrase.