We’re in a different era of HIV treatment—one where options abound and drug resistance doesn’t have to mean panic. Resistance can happen, but doctors can run a resistance test to determine the best next steps
The good news? There are backup plans.
As Dr. Monica Gandhi explains, we now have a variety of treatment options that ensure effective management of HIV, even if resistance occurs.
Here is the trasncript for this conversation.
DR. MONICA GANDHI
We’re really in a different era.
KARL SCHMID
What happens if your HIV Med stops working? That’s what we’re chatting about today. Dr. Monica Gandhi joins us. Always good to see you, doc. How are you? Thank you. Fine. Thanks so much. Let’s get right to it. We we’re talking drug resistance. How can you tell if your HIV meds are still working the way they should be?
DR. MONICA GANDHI
So if you take them, you know, regularly and every day, then they should work. And the only reason that they wouldn’t work is if the virus has developed resistance to one of the components of the medications in say, your combination pill. And that is the way to tell that the viral load is elevated even though you’re, you know, doing your best and taking those pills every day. And resistance can happen and we can actually send a test to figure out, kind of sequence the virus and figure out if resistance has occurred.
KARL SCHMID
So are there any kind of symptoms or signs that I, as the person living with HIV might start to notice? That would be cause for me to think, hang on, maybe this isn’t working.
DR. MONICA GANDHI
Yes. I mean, usually when people have resistance, again, the virus, it’s not the person, it’s the virus that’s developed to the resistance pattern to one of the components of the medication. Then the individual living with HIV can will have an elevated viral load and can feel that. Yeah, I do think that people can feel the difference between having ongoing viremia where the virus is actively replicating versus being unsuppressed, you know, completely unsuppressed and having that virus be totally down lower below the, the replication capacity of the assay. You want it to just be, you know, undetectable. So you can tell, because you’ll go in and we’ll do a viral load test and we’ll say, wait, why is this up? And, and often people can feel that. And then we just send a resistance test and there are things that we can do if it ends up being resistant.
KARL SCHMID
Right. And that was my next point. It’s important not to panic this can happen. Yes. But we’ve got backup plans. Right.
DR. MONICA GANDHI
Yeah, I mean that is actually a great point that where we are in the era of HIV is that we have so many options to treat it. And we have talked before that we have oral antiretrovirals, we have long-acting injectables, we’re getting more long-acting injectables. But we have had patients in our clinic at Ward 86 where even if they’ve developed resistance to the long-acting, we have another long acting that we can pull out and we know what to do. So it may not mean that you have to go back to oral. And then we always have kind of big gun antiretroviral therapies that we can alway that will work against any virus. We have all of that now. We’re really in a different era of being able to treat. So there’s absolutely no panic. That’s exactly right. But we have to switch if there’s viral resistance has developed,
KARL SCHMID
How common is it for somebody living with HIV to have the treatment become resistant to one or part of it’s the virus rather become resistant to one or part of the, of the drugs? Like, you know, I’ve been living with HIV for almost 20 years. Is it something that long-term survivors should sort of be checking more regularly?
DR. MONICA GANDHI
Actually it’s become less and less common. And so someone like you who knowing you probably takes your medications pretty regularly, should you may be in a situation, I hope that you’ve never gotten resistance. It’s, it’s, it’s, it’s absolutely certainly not a guarantee. It doesn’t have to happen at all. The situation in which resistance can develop is if you’re going through a hard time and things are hard in life and you’re taking the pills off and on because what leads to resistance is off and on adherence. The drug selective pressure from taking it sometimes three times a week or every other day, that actually is worse than just stopping the medication altogether. If you’re going through a hard time, if you’re going through a hard time, just stop everything and then when you are ready will put you back on. But the kind of off and on or taking it sporadically that provides what’s called the drug selective pressure to make the virus evolve resistance. And that’s what we don’t want. So, so there are people mo most people do not develop resistance at all. If there is resistance that’s developed, it’s usually has happened against more of the earlier drug classes. These ones that we’re using more now, integrase inhibitors. It’s, it’s, it’s hard to get resistant to them. They’re pretty strong and pretty, pretty, what we call a high genetic barrier resistance. So we don’t see it as much anymore.
KARL SCHMID
Yeah. And you, we, you know, you mentioned that we’ve, we talked about the long-acting injectables, you know, if I have been on a pill regime for a long time, how can switching, what are some of the pros to switching to a, a long-acting maybe? What are some of the cons?
DR. MONICA GANDHI
Yeah, I mean, the pros I think is this idea that you don’t have to remember to take that pill every day. And I think people, it’s not just, I think it’s, it can be if you set a reminder or, you know, just have it as a part of a routine. It’s not that it’s even hard to remember sometimes it’s more that you don’t wanna be in a house and show people that you have HIV or you feel internally that you don’t wanna remember stigma of HIV. There’s stigma. Exactly. External internal stigma. And so there’s a real pro about getting the antiretrovirals injected in the clinic and then going about your day and then going back every two months. So that’s the pros. But the cons are that you have to get a shot and there is, you know, the, the discomfort with the shot and then you do it to go to the clinic more frequently. Because if you take the pills every day, you can go in every six months to see the doctor. But if you take the injection, we’re now really going towards every two months for the injection, then you can, you know, you have to go in more frequently. But we’ve tried to streamline that, at least at our clinic, to make it faster when you go in, get it go out, don’t have to see the provider. But there are pros and cons. Everyone really just need to provide choice so that everyone has a choice. Because we’ve shown in every area of medicine, if you have choice people, it’s better for people feeling empowered for their Care.
KARL SCHMID
And this is probably a, a se I don’t wanna go too deep into this ’cause this is probably a, a a separate topic, but if you are pregnant or planning to be pregnant, the injectables are not necessarily always the best course during that period of your life. Am I right in thinking that
That’s changing?
DR. MONICA GANDHI
Okay. So at the beginning we were like, we don’t know enough about these injectables. What if their drug levels will go down during pregnancy or breastfeeding? So let’s not use them. That’s changing. We actually have accumulating data from what’s called the HPTN oh eight four study that looked at one of these injectables in all women, all cisgender women, and there were pregnancies and everyone quickly looked at the pharmacokinetics and how the drug levels worked. And actually it looks like they’re just fine in pregnancy. Good. So if that’s what works for you and you’re planning on getting pregnant, then stay on those long acting.
KARL SCHMID
I love that. What, what are some of the proactive things that I can do to, to make sure that my treatment is working?
DR. MONICA GANDHI
Yes. I mean, you know, we have gone back and forth in this, but it, it really seems like taking it every day is the right approach. It used to be, oh, maybe you can do five days a week. I actually think that every day not only controls the virus, it controls the inflammation from having HIV. So taking the drug every day, that is the best thing you can do. Putting it right next to your coffee pot or whatever it takes to remember to take it every day. And then if you can’t, because life happens, think about talking to your provider about long acting. And if worse comes worse and you need a break, then breaks can happen. I mean, that’s not, it’s not impossible to conceive that you should need a break for a couple of weeks. But again, if you need a break, stop taking it all together. Don’t take it off and on, and then we’ll get you back on something that helps, helps you. And
KARL SCHMID
I think important to stress. If you, if that is the option you’re thinking, be talking with your healthcare provider and making those decisions together. Don’t just do it on your own whim and not talk to anyone about it. I just wanna stress that. I think it’s very important. Yeah, you’re, that is a decision you make in, in partnership with whoever’s taking care of you from, from the medical side.
DR. MONICA GANDHI
Yes.
KARL SCHMID
And I guess lastly, Dr. Gandhi and it’s, I, these go by so quickly. I think it’s very important to continue to stress that, you know, a person living with HIV can live a very long, happy and healthy life thanks to these drugs. Whether you become resistant to one and have to switch, bottom line is the, the, these are important for us.
DR. MONICA GANDHI
Truly, everything has massively changed in the world because we have these long acting anti, I mean, sorry, short acting, long acting doesn’t matter. Anti about therapy works. It makes you have a totally normal lifespan. If you can take it every day and forget about it, your life is actually quite unchanged and it really, they really work to maintain your health. Please, please get on on judgmental therapy.
KARL SCHMID
Dr. Gandhi, thank you so much for taking the time. Always a pleasure to see you.
DR. MONICA GANDHI
Thank you so much.
KARL SCHMID
That’s gonna do it for this episode of plus talk here at plus life where we’re all about turning positive into a plus. If you want more information, check out the website and remember, you can follow us across social media. We are at plus life media. Until next time, if you’re HIV positive, remember take your meds. See ya.