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If You Change To New HIV Medicines (ARTs), Can You Go Back To The Old Ones In The Future?

ART drugs are a class of new HIV treatments that are extremely effective against the virus. However, not every drug in this class works the same for every person. Depending on several medical (and some non-medical) factors, you may have to change to a different drug in the same class. However, if you change to new HIV medicines, can you go back to the old ones in the future?


Whether or not you can change back to your old drugs once you’ve started a new HIV medication depends on a lot of factors. The reason your drugs were changed in the first place is extremely important. Ideally, you shouldn’t change back to your old drugs if your HIV infection developed resistance against them. Talk to your healthcare provider to assess your specific situation.


HIV treatment, however successful, is very delicate and requires meticulous care. Physicians need to be extra careful when prescribing or changing drugs in a treatment regime. Careless addition or removal of HIV drugs from a treatment plan may cause the virus to develop resistance against them. 


CAN YOU GO BACK TO THE OLD HIV MEDICATIONS ONCE YOU CHANGE THEM?

There is no single, yes, or no answer to this question. Two important factors determine whether or not you can go back to the old HIV medication once you change them: the reason for changing the drug and HIV drug resistance. Theoretically, if there is no risk of developing HIV resistance to the new drug – or if the person did not become resistant to the old drug – they could change back to the old one, given the right reason. However, this should be discussed and decided with a healthcare provider.


HIV drug resistance means that the drug becomes incapable of eliminating the virus in your body. Essentially, the virus mutates to change its genetic makeup. This change in the viruses' genetic makeup renders the drug ineffective against them because the drug can't bind to them as effectively as it could before. HIV treatment, especially ART treatment, works by attacking the RNA of the virus directly. However, the treatment can't run its course if no virus-drug complexes are formed in the first place. 


HIV drug resistance usually occurs in response to frequent changes to a treatment regime. Incomplete drug therapy as a result of poor adherence to treatment is another important factor for the development of drug resistance. However, a patient with excellent ART adherence may still develop HIV drug resistance because their body may not absorb the drug properly. People with chronic gastrointestinal conditions are usually at risk.


HIV drug resistance is a growing problem. In the US alone, 12% to 24% of HIV-positive people have developed HIV drug resistance. The reason why HIV drug resistance is so prevalent is that its effects are twofold. The resistance doesn't only affect the function of the drug the virus became resistant to, it also renders other drugs that bind to the same receptors or use the same mechanism of action useless. 

If the reason for changing the drug in the first place was the virus developing resistance against it then you can't go back to using the same drug afterward. The development of resistance against the old drug may also put the new drug at risk for developing resistance. A great way to check if drug resistance is present is to monitor the progression of the disease. If the patient fails to achieve an undetectable viral load even after using a drug for several months, it's possible that the drug may not be as effective against the virus because of the resistance. However, there are other reasons, aside from drug resistance, for people and physicians to change HIV drugs in a treatment regime.


REASONS TO CHANGE YOUR HIV MEDICATION

The biggest reason for changing a drug in an HIV treatment regime is the development of drug resistance. Another important reason is a virological failure. Virological failure refers to the inability of the drug to suppress the viral load in your blood. Although drug resistance is a major cause of virological failure, there are several other reasons for it as well. These reasons include malabsorption, decreased metabolism, enzyme deficiencies, an extremely high viral load, and some drug-to-drug interactions. 


Like any other medication, ART therapy employed for HIV treatment has side effects as well. These side effects are usually mild and most patients can make do with them for extended periods. However, changing the treatment regime becomes necessary sometimes because patients develop unbearable side effects. Potential long-term side effects of HIV treatment include:

  • Central nervous system disturbances
  • Renal problems
  • Hepatic injuries
  • Bone resorption
  • Long term fatty deposits


Many patients have to change their HIV treatment simply because they have a concurrent medical condition. Conditions like hepatitis B and hepatitis C also require antiviral therapy. The drugs used for hepatitis treatment may interact with anti-HIV drugs and cause problems with metabolism or excretion. The onset of pregnancy may also warrant a change in HIV treatment to include pregnancy-friendly drugs in the treatment regime. 


Apart from all of these medical reasons, there may also be non-medical reasons for changing drugs in an HIV treatment regime. The cost of a drug, its geographical availability, its half-life, as well as the minimum, required duration of use greatly influence treatment adherence.


HOW TO KNOW IF YOUR HIV TREATMENT IS WORKING?

As discussed above, there are several alternatives available in an HIV treatment regime. Doctors may change certain drugs in a treatment regime if they conclude that the treatment isn't working anymore. There are conclusive tests available that show how well the treatment is progressing and whether a change in treatment is required or not.


Regular blood tests provide sufficient evidence of the effectiveness of HIV treatments. Two metrics are often examined with these blood tests: the viral load & the CD4 cell count. 


Your viral load defines the number of virus particles present in your bloodstream. If the viral load remains low, it is a good indicator of successful treatment. An undetectable viral load means that the number of virus particles is so low that they cannot be detected by the test. It usually occurs when the viral load hits numbers below 50. An undetectable viral load is achieved usually after 4 to 6 months of starting an anti-HIV treatment.


The CD4 cell count also gives a good indication if the treatment is successful. CD4 cells are your immune cells that the virus targets first during an infection. The number of CD4 cells decreases rapidly during an infection, decreasing their immunity along with them. With successful treatment, the number of viral particles in your blood decreases, also decreasing the attack on CD4 cells. Thus, if the CD4 cell count is rising in a patient who is taking active HIV treatment, it usually indicates that the treatment is working.


WHAT TO DO IF YOU DEVELOP RESISTANCE AGAINST HIV TREATMENT?

The best thing to do when your HIV treatment is not able to suppress your symptoms is to consult your doctor about the problem. Your doctor may evaluate your condition and conclude that your HIV infection has developed resistance against the treatment. Your doctor may then change certain drugs in your treatment regime to ensure that drug resistance doesn't cause your treatment to come to a halt. 

It is also helpful to work with your doctor and figure out why drug resistance became a problem in the first place. Figure out the cause: was it poor drug adherence, poor drug availability, malabsorption, or any other factor. Your doctor may take an extended medical history as well as run some tests to figure out the cause of drug resistance.


People who miss occasional doses are not at a much higher risk for developing resistance. However, patients who miss their doses frequently risk developing resistance much faster and with much more certainty. The best thing you can do to avoid the development of resistance is to take your HIV drugs regularly and on time.


RELATED QUESTIONS

Q) How Effective Are ARTs In Treating HIV?

ARTs cannot cure HIV. However, these drugs can manage HIV effectively to minimize the symptoms for a patient. With the regular and correct use of these drugs, the symptoms of HIV can be managed to a great extent within the initial six months.


Q) What Happens If I Stop Taking My HIV Medication?

Failure to adhere to your anti-HIV treatment can be devastating because it can lead to the development of drug resistance. The development of drug resistance against one type of drug may also confer resistance against other drugs from the same class. Resuming effective treatment later becomes extremely difficult.


Q) Can I Have Sex With My HIV Negative Partner If I’m On Treatment?

If you are taking your anti-HIV treatment regularly and you also have an undetectable viral load, you have a low risk of transmitting the virus to your partner. Wearing a condom during sexual intercourse is still recommended.


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