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The goal of HAART is to reduce the amount of HIV your blood.
The treatment should stop you from becoming ill for many years.
Sometimes, HAART works without any major problems or setback,
but sometimes there can be problems. HAART have not been around
for a very long time. Despite, on-going research and development,
there are certain problems and issues associated with HAART.
Here you can find some information about the issues you might
face when on HAART.
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| HAART slows down the reproduction of HIV
in the body. But the drugs cannot stop the reproduction of HIV
completely, and so some HIV is able to survive despite on-going
treatment. |
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| HIV reproduces itself very quickly and
when reproducing often makes slight mistakes. So each new generation,
or new strain, of HIV differs slightly from before. These tiny
differences in the structure of HIV are called mutations. Some
of the mutations occur in the parts of HIV, which are targeted
by the drugs. |
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| So although you have some HIV that continues
to be affected by the drugs, you have other strains of HIV that
are not affected by the drugs as effectively as before. This
is called drug resistant, and it enables HIV to reproduce without
being affected by the drugs. |
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| When someone has drug resistance, the amount
of HIV rises and the risk of a person becoming ill increases.
Drug resistance is one of the main reasons why HAART can fail.
If resistance to current drugs is developed, this usually means
that the drug regime needs to be changed. |
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| There are certain things that can be done
to minimize the risk of developing drug resistance |
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- Regular viral load testing. Viral load test can indicate
if you are developing drug resistance. If viral load increases
above 'undetectable' level, this could be sign of growing
drug resistance.
- Adherence - taking drugs exactly as prescribed is a very
important part of avoiding resistance. Missing doses or
not taking drugs on time lowers the amount of drugs in your
body. Therefore, HIV is not properly suppressed and HIV
is able to reproduce itself faster and increases risk of
developing resistance.
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| If HIV is resistant to a particular drug,
it will sometimes be resistant to similar drugs in the same
group. This is called cross-resistance and it means that some
drugs from the same group might not work for you even though
if you have used it before. |
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| For example, if you develop resistance
to one drug of the non-nucleoside (NNRTI) group, there is a
risk that the other drugs in the non-nucleoside (NNRTI) group
might not be effective for you. |
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| Cross-resistance is a particular problem
and limit treatment options available for people. In Malaysia,
we do not have specific resistance testing to determine which
particular drugs we are resistant to. |
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| There are 2 main reasons why drug combination
sometimes needs to be changed. |
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| Firstly, if a person develops resistance
to the drugs, in which the drugs fail to work and slow down
the reproduction of HIV in the body. An increased level of viral
load is sign of failing treatment. |
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| Secondly, when the drugs often cause side
effects. Sometimes these side effects are so strong and intolerable
that the combination has to change. |
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| The combination drugs work at its best
when used the first time. This is one of the reasons why treatment
change has to be considered carefully and whether a change is
really necessary. The combination drugs other than the first
combination is called salvage therapy. It is also referred to
as second line, third line or rescue therapy. |
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