Mar. 16, 2005 Despite medicine’s growing arsenal of potent therapies against HIV, some HIV patients become resistant to drugs — often because they cannot keep up with demanding drug regimens.
As a result, physicians such as Kathleen Squires, associate professor of medicine in the Keck School of Medicine of USC, now work with counseling teams that help patients adhere to their schedules.
Squires, an expert in antiretroviral drug development and issues related to HIV infection, spoke about the adherence teams at an American Medical Association media briefing called “HIV/AIDS: The Drug Resistance Epidemic,” recently held in New York City.
Anti-viral drugs slow down the reproduction of HIV in the body. But HIV can change slightly as it reproduces, and sometimes the changes allow it to escape the virus-fighting effects of drugs — making new strains more drug resistant.
The more tightly patients adhere to their drug regimens, the more these patients can keep the virus under control; going off their schedules may give HIV a greater chance to reproduce and create resistant strains.
For each patient who becomes drug resistant, health-care professionals must work together to understand the challenges faced by that patient, said Squires, medical director of the LAC+USC Medical Center HIV/AIDS clinic, or “5P21,” one of the nation’s largest AIDS clinics.
“We assign a core team to work with a person who has anti-HIV drug resistance, including a physician assistant, nurse and a social worker,” Squires said. “We want to get to the root of the problem and understand how adherence became a problem for the person.
“In some cases, we will provide an adherence counselor offering either group or individual counseling at a variety of locations: the clinic, a community-based organization or at the patient’s home. Another option is directly observed therapy, which is an intensive program where individuals take one or more of their daily doses under the supervision of the adherence staff, either at the person’s home or the hospital.”
Squires said health professionals who work with HIV/AIDS patients never give up on those whose HIV becomes drug resistant.
“We continue to treat a person because we want to decrease the virus replication and help boost the immune system,” Squires said. “If a person becomes resistant to treatment medication, it’s better to continue a course of anti-HIV drugs than not treat the infection at all.
“Even with resistance there remains some benefit from treatment, as a person is less likely to develop an infection causing additional complications,” she said.
Recent advances in anti-HIV drugs have helped decrease the number of people combating resistance because the medications are easier to take and present fewer side effects than previous treatments.
“When we first started treating HIV many years ago, we were asking people to take three different drugs consisting of multiple pills that had to be taken multiple times each day,” Squires explained. “It isn’t surprising people ran into trouble and developed resistance, because the medication was so complicated to take.”
Squires is optimistic about what doctors will soon be able to offer patients.
“For physicians, the exciting news is we now have access to new agents in the clinical pipeline that are developed specifically for patients who harbor a resistant virus,” Squires said.
“Future developments will include medications that encompass all aspects of treatment into one pill. This is ideal because we can incorporate the treatment into a person’s lifestyle,” she said.
“If we’re not asking people to change their whole lifestyle, they have a much better chance at success.”
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