Drug-Resistant HIV

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

How can a really bad virus be made even worse? How about a mutated version of the really bad virus? This lesson goes over the issue of drug resistance and HIV.

Drug Resistant Bugs

There's something that's been in the news for a while. It's called the post-antibiotic world. Antibiotics are drugs that kill bacteria. They are a gigantic reason for why lifespans have increased in the last century. But antibiotic misuse and bacterial mutations have rendered some of our best defensive weapons (the antibiotics) useless against some of the most advanced, newer, bacteria out there. People die because we have no antibiotic that can stop their super-bug infection. Scary, right?

Well, there's something similar going on with an extremely deadly virus: HIV.


HIV is scary on its own, without any drug resistance. HIV is the human immunodeficiency virus. It destroys our immune system's ability to fight off an infection. Think of our immune system as a built-in army. It can track down and kill bacteria, viruses, fungi, and parasites. Now imagine taking that army away. Logically, what would happen? The bacteria, viruses, fungi, and parasites would have free reign over our body. This is what happens in people who have an advanced stage of HIV called AIDS, or acquired immune deficiency syndrome.

HIV (green) popping out of a white blood cell (in blue).

People with AIDS are susceptible to getting some of the worst infections out there since they can't protect themselves without an immune system. But wait, it gets worse. A person with AIDS will also fall ill as a result of once nearly harmless bugs. A healthy person's immune system cannot fight off every kind of infection but it can easily defend itself against puny infections. But people with AIDS cannot, and they can die from even the puniest bug.

Do you know how we can stop a person infected with HIV from getting AIDS? We use drugs that help suppress, but not cure, HIV. Meaning, we try and stop it from replicating and thus multiplying within our body. However, there is no cure for HIV right now. So the best we've got against this scary virus are drugs that slow it down as much as possible.

HIV Drug Resistance

Now imagine those drugs failing to work. That leads to a lot more people with AIDS. A lot more people dying from even the simplest infections. A lot more tragedy. This is what we are beginning to face with HIV, although not to the same extent as the bacteria (yet).

Just as bacteria can mutate (evolve) to combat antibiotics--remember they want to live as much as we do--viruses can do the same thing. Actually, viruses mutate all of the time even without any help from us. Think of the seasonal flu virus. The reason so many people get the flu on a yearly basis is because the flu virus keeps mutating. That's why there's no cure for the flu, only vaccines for some kinds of flu.

HIV is no different. It doesn't want to be killed or suppressed by our HIV drugs. It wants to live! So, it mutates. As our drugs force HIV's hand and HIV mutates to resist those drugs, the drugs become ineffective. Meaning, drug-resistant strains (variations and forms) of HIV can develop. This means HIV treatments can fail since the drugs the person once took no longer beat back the HIV.

Sometimes, like improperly used antibiotics lead to bacterial mutation, improperly used HIV drugs may cause HIV to mutate. This may occur if the wrong combinations of drugs are used, not enough of the drug is used, or the drug regimen isn't followed properly by the user. In some people, this drug-resistance develops only after they've begun HIV treatment, but other people can be infected with drug resistant forms of HIV right off of the bat from another person.

If it's hard to understand why, think about this metaphor. Imagine a drug is a bullet designed to kill HIV. HIV mutates and develops a bullet proof vest. That vest won't stop very powerful bullets and it won't stop other methods of suppressing HIV, such as a blow to the head with a baseball bat, but it will stop lots of very similar bullets nonetheless. That's cross-resistance. Cross-resistance doesn't stop all HIV drugs since some are more powerful or target other areas of HIV with different means, but it does stop similar drugs.

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