Does CD4 decline mean drug resistance?
A growing body of research has confirmed that the effectiveness of antiviral therapy should be met with an undetectable viral load and a gradual increase or stabilization of the CD4 cell count.
Under the premise that the virus is effectively inhibited, the fluctuation of CD4 cell count within the normal range cannot directly represent drug resistance, and will not have adverse effects, so there is no need to worry too much.
Seasonality, circadian differences, co-infection, low white blood cell count, and use of cortisol drugs can all affect CD4 cell counts.
What is HIV drug resistance?
In layman's terms, it means that there is resistance to drugs used to treat HIV, and the treatment effect is reduced or ineffective.
When is testing for HIV drug resistance indicated?
The 2020 edition of the National Technical Specifications for HIV Testing puts forward the following three points:
1. It is recommended that qualified patients do drug resistance testing before taking the drug. There is no condition, take the drug for half a year to check the disease, the disease load can not be detected, and there is no need to do drug resistance.
2. After taking the drug for half a year, if the disease load is greater than 1000, it is recommended to do drug resistance testing.
3. After taking the drug for half a year, if the disease load is greater than 500 and less than 1000, the hypersensitivity method can be used to detect drug resistance.
Why does drug resistance develop?
(1) Don't take medicine well, don't take medicine well, don't take medicine well!
In general, the most common clinical treatment is acquired drug resistance, also known as secondary drug resistance. It is mainly caused by the patient not taking the medicine well, not following the doctor's instructions, and not taking the medicine on time.
Do I have to take my medicine at the right time?
- No!! as for why, look at the picture below.
Drugs are usually only effective within the time interval marked in the expiration date, if the drug in the body is lower than the effective concentration, the antiviral ability will be weakened, the HIV virus itself is extremely cunning, in the fight against the drug again and again, this cunning virus is very easy to obtain the ability to tolerate survival.
As a result, drug resistance developed.
(2) Transmissible drug resistance, also known as primary drug resistance. That is, when infected, it is a drug-resistant strain.
There are three main factors in the development of HIV drug resistance:
1. The virus itself:
HIV is a highly mutable virus, and the virus replication process is complex, and even if there are no other interfering factors, the virus itself has mutation opportunities.
2. Patient's reasons:
Currently, the majority of HIV drug resistance is related to non-adherence to medication (non-standard medication). For example, individual infected patients ignore the importance of taking medication on time due to their inconspicuous symptoms, and arbitrarily interrupt or reduce the dose of medication. There are also a few infected people who are unable to adhere to treatment due to side effects of the drug. These non-standard and intermittent treatments lead to unstable blood drug concentrations, continuous mutation of viruses under the pressure of drug selection, and more and more mutant strains of drug resistance genes, and finally drug resistance
3. Drug causes:
When formulating a treatment plan, if a drug with a low resistance barrier is selected, and the patient himself cannot comply with the drug, drug resistance can be easily induced. Judging from the existing clinical situation, drug resistance due to the low antiviral effect of drugs and the low resistance barrier should also cause vigilance.
In general, if medication adherence is good and viral load inhibition is below 50 copies/ml, no new resistance mutations will generally appear, and the latent viral type in vivo is consistent with the viral type in serum.
When the viral load is not completely suppressed for a long time, it is possible to develop new drug-resistant mutant strains, and the possibility of drug resistance is relatively high.
When is drug resistance testing done?
It is recommended that those who have the conditions should do drug resistance genetic testing as soon as possible after being diagnosed with HIV, because it is more accurate to do drug resistance testing when the HIV disease load exceeds 2000 copies/ml. It can guide doctors to formulate treatment plans, use drugs scientifically and accurately.
HIV-infected patients who have been on antiviral therapy for 12 months and have a viral load of >1000 copies/ml should also be tested for resistance before switching regimens.
In addition, resistance testing may also be considered for patients with a viral load between 500 and 1000 copies/mL after 12 months of treatment. Note that blood samples should be collected within 1 month of still taking the drug or stopping the drug, otherwise the results may be inaccurate if the disease load is less than 2000 copies/ml.
How to prevent drug resistance
1. It is recommended that newly diagnosed patients with HIV infection should be tested for drug resistance before starting antiviral therapy, and try to avoid the use of drug-resistant or potentially drug-resistant drugs.
If conditions permit, it is recommended to choose drugs with strong virus inhibition and high drug resistance barrier at the beginning of treatment, so as to obtain good treatment effect and quality of life, reduce the occurrence of drug resistance, and ensure the success of long-term treatment.
2. Take medicine strictly according to the doctor's instructions. In order to ensure the effectiveness of antiviral therapy, at least 95% of the medication compliance should be ensured, for example, the doctor's order requires 30 doses per month, and the medication compliance is required to be 95% or greater, in other words, the number of missed doses should not exceed one and a half times per month to ensure the treatment effect. If you take the medicine only 20 times on time, then the chance of success of the treatment is only 70%, and so on;
3. Pay attention to follow-up Regularly test viral load, CD4 cell count and other indicators to evaluate the effect of antiviral therapy, timely detect the adverse reactions of antiviral drugs, and whether viral resistance occurs, etc., and change drugs in time to ensure the success of antiviral treatment. At the same time, do a good job of self-management, pay attention to and detect changes in various physical indicators in a timely manner, and contact the attending doctor in time if you find that the data trend is abnormal or the viral load rebounds;
4. Keep in touch with the attending doctor daily to understand the contraindications of antiviral drugs and other drugs, such as those taking Biduxvid, dolutegravir (DTG), Jiefukang, etc., and avoid taking multivalent ionic drugs (magnesium, aluminum, calcium, antacids, etc.). If necessary, it should be taken at least 2 hours apart. In addition, nausea, dizziness or rash may occur during the treatment, so you should contact your doctor immediately and do not self-medicate other medications to avoid covering up or aggravating the condition. Moreover, it is not possible to stop the drug without authorization, which will cause the virus to rebound and drug resistance may occur;
5. Adhere to the correct use of condoms to reduce the risk of cross-infection and prevent other STDs.
In addition, maintain an optimistic attitude and avoid negative emotions such as depression and anxiety affecting the treatment, thereby increasing the risk of drug resistance. It is recommended to relieve psychological pressure through confiding, psychological counseling, etc.
A strong heart, a peaceful and optimistic mindset, a healthy and disciplined diet, and consistent exercise are the secrets to a youthful mindset. Every year really goes by so fast, the time flies by, and you are healthy and happy every day!