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By: Ana Mixon

June 2, 2023

Can HIV Treatment Stop Working?

Modern HIV treatments have allowed many HIV patients to almost forget about their diagnoses, effectively controlling their viral loads through daily medications. But because HIV is susceptible to drug resistance, you must understand how your HIV treatment works and that it may stop working over time. 

Human immunodeficiency virus (HIV) isn't just a single virus — it consists of numerous variants, some of which are resistant to drugs. While your HIV medication may work for a time, these drug-resistant strains can eventually become dominant. Your health care provider may need to adjust your treatment regularly. 

Can HIV treatment stop working? Does HIV treatment work for everyone? And what happens when treatment options no longer work for you? In this guide by Rapid STD Testing, learn everything you need to know about HIV drug resistance. Then order a rapid STD test to test your viral load and ensure that your HIV treatment is working at full effectiveness. 

Medicating for HIV 

The US Food and Drug Administration has approved over 50 HIV medications that are available on the market. Your doctor may prescribe pills, shots, or a combination of both. 

The purpose of HIV medications is to prevent the virus from replicating, reducing the amount of HIV in your body. 

Your health care provider will conduct HIV testing to determine the right combination of medicines to thwart your HIV strains. They will conduct a 10-panel STD test, test your viral load, and determine whether you have any drug-resistant strains. They will also consider any other medications you're taking and your overall life situation to create a suitable treatment plan. 

Most HIV patients need at least two medications for effective viral suppression, though some drugs contain more than one medication in a single pill. Targeting your HIV strains from multiple angles is the most effective way to suppress your viral load, which is the amount of the virus detectable in your blood.

HIV medications are antiretroviral, meaning they inhibit the activity of HIV. Many classes of antiretroviral drugs exist, such as:

  • Integrase strand transfer inhibitors: Stop the action of the viral enzyme with which HIV infects T cells
  • Fusion inhibitors: Prevent the HIV envelope from integrating with the white blood cells
  • Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): Prevent HIV from making copies of itself
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs): Act similarly to NRTIs without the use of non-nucleosides

How long does HIV treatment last? HIV treatment to reach undetectable levels usually takes between six and twelve months, but you'll stay on antiretroviral therapy with periodic checkups with your doctor.

Side Effects of HIV Medication 

Like any drug, HIV medications can come with side effects. Your doctor will work with you to determine a treatment combination that produces more benefits than adverse side effects. 

Common side effects of taking HIV medications include: 

  • Fatigue
  • Headache
  • Diarrhea
  • Liver problems
  • Long-term appetite loss and weight loss
  • Upset stomach

Different classes of HIV medications also produce more specific, dangerous side effects. These effects range from fat problems to heart disease and diabetes to sleeping problems. Your health care provider will discuss the potential side effects of your treatment plan so you know what symptoms to look out for when beginning a new treatment. 

What Is HIV Resistance?

So can HIV treatment stop working? Yes — because of drug resistance.

One reason why HIV is hard to treat is that you can develop HIV drug resistance. HIV medications stop working, and your body no longer responds well to the drug treatment.

Because HIV is not just a single virus, the different strains within your body respond to treatment differently. Your HIV will also change and mutate over time. The treatment that once controlled your viral load may no longer work because a mutation has developed that resists the medication. 

These mutations may develop through a few different means:

  • Acquiring a different strain of HIV through sex or shared needles
  • Having a high baseline viral load that makes treatment less effective
  • Interactions with other drugs you're taking
  • Poor drug absorption, such as due to chronic diarrhea
  • Previous treatment failure, which may make you more likely to resist future treatments within the same drug class 
  • Poor adherence to treatment due to harsh side effects, affordability, or mental health problems 

Your physician will conduct testing to classify the type of drug resistance impacting your treatment:  

  • Virologic failure is the inability to keep your viral load below 200 copies per milliliter even with adequate treatment adherence.
  • Immunologic failure occurs when the defensive immune cells your HIV attacks fail to recover after treatment. 

How do you know if your HIV medication is not working? You can look out for potential HIV drug resistance symptoms, which often mimic the flu. You may experience the same symptoms you did when you first contracted HIV. 

Preventing HIV Drug Resistance

Why can HIV treatment stop working? HIV drug resistance may occur due to issues outside your control, such as a high viral load or malabsorption issues. But in many cases, drug resistance occurs because patients do not take their HIV medications consistently or follow the necessary protocols to improve drug efficacy. 

Preventing HIV drug resistance involves:

  • Taking your medication as prescribed and avoiding missing any doses
  • Considering and addressing potential issues that may prevent you from taking your medication every day, such as a lack of health insurance or an unpredictable schedule
  • Reducing side effects with over-the-counter medications if applicable to improve adherence
  • Being transparent about any drugs you regularly take that could impact absorption
  • Practicing safe sex and avoiding needle sharing to prevent acquired drug resistance
  • Fully understanding what happens if you stop taking HIV meds

Drug-Resistance Testing

Your doctor will conduct drug resistance testing at the onset of your HIV symptoms and as soon as you notice signs of drug resistance. The type of testing depends on the type of failure; for example, you may need reverse transcriptase and protease genotypic testing for virological failure.

Most tests require a blood sample, which the lab will evaluate to determine the genetic structure of your HIV and recommend further treatments. 

Changing HIV Treatment 

If you develop drug resistance to your current HIV treatment, you may need to switch to a new treatment. Your physician will use your drug resistance testing results to determine which drugs may work. 

You'll conduct genetic resistance testing while taking the drugs that are no longer working, allowing your physician to examine your viral pool while the drug-resistant HIV variants are dominant. If you stop taking your treatment for more than four weeks, the original predominant variant will return to the forefront of results, skewing your testing. 

Your health care provider may also order phenotypic testing, which directly exposes your variant of the virus to HIV drugs to determine which would be most effective. 

With the results of these tests in mind, your physician will determine a new combination of drugs to treat your HIV variants. You'll likely switch out multiple drugs instead of just one, as only changing one drug would make you vulnerable to future mutations or allow your variants to become even more resistant to treatment. 

Your health care provider may also recommend drugs in a different class than what you were previously taking.

To account for the new level of resistance, you may need to up your dose of existing medications that were actively lowering your viral load before the drug resistance developed.

Begin your new treatment as soon as possible to help return your viral load to a stable level. If you and your doctor can pinpoint why your drug resistance developed, discuss how you will prevent further drug resistance, such as by setting a reminder to take your medication each day.

Above all else, be transparent with your physician. They will not judge you or reprimand you for forgetting to take your medication or having unprotected sex. They just want to help you live a healthy life.

Stay Proactive About Your HIV Treatment

Can HIV treatment stop working? Unfortunately, yes. Your physician will likely need to adjust your treatment plan over time to account for drug resistance. 

But staying proactive about your HIV treatment can help you avoid drug resistance and improve your quality of life. For example, you may want to take advantage of same-day STD testing regularly to test your viral load and catch any other STDs in the early stages. 

Order STD tests from Rapid STD Testing today, and learn more about HIV in our guide answering “How long can HIV stay dormant?

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By: Ana Mixon
June 2, 2023

Ana Mixon is an accomplished and knowledgeable medical writer who excels at conveying intricate medical information in a concise and understandable way. With a strong foundation in internal medicine, Ana possesses an in-depth comprehension of cutting-edge research and advancements in the healthcare sector. Her passion lies in making complex medical concepts accessible to a wide range of readers.

With years of experience under her belt, Ana has honed her skills in medical writing to perfection. She consistently produces high-quality content that is both informative and engaging, ensuring that readers can grasp even the most intricate details with ease. Her dedication to the craft is evident in her unwavering commitment to staying abreast of the latest developments in medical writing. Ana actively participates in conferences and workshops, constantly seeking opportunities to enhance her skill set and remain at the forefront of her field.