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Treatment in asymptomatic individuals may speed up the development of deadlier virus strains

Even as researchers creep closer to eliminating the human immunodeficiency virus (HIV) in some patients via intense multi-drug therapies and early treatment, researchers at the University of Southern California warn that the responsible treatment may give rise to new killer strains that resist drugs.

The USC study hits close to home as the Los Angeles county targets men who have sex with men (MSM) -- a high-risk group for HIV/AIDS -- with a so-called "test and treat" strategy.  The strategy pushes for universal testing -- particularly between MSM and other high-risk groups.  It calls for early retroviral drug treatment in individuals who test HIV positive.

The approach has thus far lowered the death rates and decreased the number of cases.

The USC researchers dug into data on MSM infections, which account for 82 percent of total known HIV infections nationwide.  Using data from the Centers for Disease Control, internal data, and knowledge of drug resistance, the researchers modeled the occurrence of drug resistant viral strains if the "test and treat" strategy was aggressively followed over the next several years.

The study suggests that the rates of multiple-drug-resistant HIV (MDR) could jump from 4.79 percent to 9.06 percent.

HIV treatment
Early HIV treatment may increase drug resistant viral strains.
[Image Source: Tomorrow Global]

The researchers say their results show a danger of over-treating the disease with drugs.  They suggest that while the widespread testing is a good idea, that the medical establishment should back off preemptive treatment in asymptomatic individuals.

USC Professor Neeraj Sood, who was a lead author on the study, suggests that much of the benefit comes from the knowledge of infection status.  He comments, "We’re not saying that testing everybody and treating everybody is bad. All we’re saying is that you should proceed with caution and closely monitor the prevalence of multi-drug-resistant HIV as you scale up the test and treat model.  Prior studies show a dramatic reduction in risk-taking behavior by individuals once they know their HIV-positive status."

The research was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and published in an edition of this month's Clinical Infectious Diseases journal.

Sources: USC [press release], Clinical Infectious Diseases [abstract]





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