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Anti-HIV drugs could be useless for nearly half of patients within four years, according to a computer model prediction.
The new study, using data from the San Francisco gay community, suggests that by 2005, at least 42 percent of HIV cases could be drug resistant. In 1997, the figure was less than five percent.
The researchers found that unprotected sex is unlikely to be the cause of an epidemic of drug resistant strains. Instead, resistance appears primarily to be caused by patients who are taking the drug cocktails not sticking to a strict pill-popping regime. Any deviation from the treatment programme can allow the virus the opportunity to replicate and develop resistance.
This presents a serious problem as the health of people infected with HIV has been vastly improved by the drugs. Resistant strains can multiply unchecked, suppressing their host's immune system so that illness and death follow.
"The emphasis needs to be on stopping drug resistance in the first place,'' rather than preventing transmission of resistant strains, said lead researcher Sally Blower, from the AIDS Institute at the University of California, Los Angeles. She pointed out that doctors need to be as vigilant as patients in making sure correct treatment programmes are followed. She recommends creating specialist treatment centres for the disease.
The results have serious implications for developing countries, where it may be even more difficult to ensure medication is taken correctly.
"For resistance to occur you need the virus to evolve," says HIV specialist Andrew Phillips from the Royal Free Hospital, London. He told New Scientist that if patients follow an intensive regime that includes three different classes of drugs, the virus cannot replicate enough to evolve.
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