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HIV - Understanding The 1st, 2nd & 3rd Line Of Drugs!

Written and reviewed by
Dr. R.Pavan Kumar 89% (39 ratings)
MBBS, PGDHS,PGDHIVM
General Physician, Nalgonda  •  12 years experience
HIV - Understanding The 1st, 2nd & 3rd Line Of Drugs!

HIV-Human Immune Deficiency Virus is a virus known all around the world and has contributed to a large number of deaths over the years. As its name suggests, HIV is a virus that attacks an individual’s immune system by destroying the white blood cells and reproducing itself inside the same cells. This slowly weakens the immune system of the affected person and eventually, without treatment the body finds it difficult to fight any disease. A person with HIV, and taking no treatment, is estimated to survive for ten to fifteen years. However, this also depends on the health, background, and age of the patient.

The treatment for HIV has been a huge challenge for the medical fraternity, ever since the virus was identified some years ago. The difficulty with this particular virus is that it spreads itself or multiplies, and this poses a different kind of challenge for physicians. In the process of multiplying, this virus can alter its form, which is medically known as mutation and the newly formed or mutated virus can be resistant to the drug being administered. The doctor will then have to recommend a second line of treatment and prescribe another set of drugs. In some HIV patients, a third line may also have to be resorted to after observing the progress with the second line of drugs.

Drug Resistance Tests Used
When a person is under HIV treatment, it may emerge that the drugs are not yielding the results expected from that line of treatment. It is then that the doctor will advise a drug resistance treatment to determine the resistance level of the virus, and therefore, a new set of drugs will then be prescribed. With experience, doctors have now started advising drug resistance tests on new HIV patients also. This is to check which drugs the virus is resistant to. This is similar to the culture analysis conducted in the conventional system.

Second and Third Line of Drug Resistance

A lot of research has already been done to find the cause of failure for the first line of treatment of HIV and how the second line can then be started. But there are cases, where about 3% of patients develop resistance to the second line of drugs being administered as well. It may not be practically feasible for the medical team to detect the level of drug resistance at the time of starting one level. This is because the multiplication and mutation of the virus might start to occur after some time. Doctors will therefore have to wait for a while before the drug resistance test can be done. This holds equally good for the subsequent levels as well.

Choosing an Optimal Path Essential
After studying the impact of the virus mutation and the difficulties posed in the treatment of HIV, doctors have now turned to planning the treatment in an optimized manner. The patient is put through tests to identify the virus and then the appropriate combination of drugs is prescribed. Subsequently, a close surveillance is maintained to monitor the outcomes and progress of the treatment. If any new mutations occur, then the treatment course is modified to ensure that the effect of the mutations doesn’t cause any further damage to the patient. Ensuring the patient follows the treatment regimen stringently is a challenge and patients have to cooperate with the medical team to see that they don’t miss a dose of medication even once. 

The progress from line one to third line regimen shows development in treatment options. While reports show that more patients die when the second regimen is being undertaken, a lot of value and research are being put towards the third dline. Increasing access to first line of treatment in some countries are constrained and it would be difficult for patients to get third line treatment.

In case you have a concern or query you can always consult an expert & get answers to your questions!

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