The stigma surrounding the Human Immunodeficiency Virus is lessening-but so is the effectiveness of current methods of treatment. HIV is constantly evolving and developing drug resistance, and a recent study led by Matthias Götte, of McGill's department of immunology and microbiology, investigated how mutations in the virus' DNA contribute to the problem.
"We are working on HIV drug resistance in terms of the biochemical aspect. We try to understand how the virus develops resistance… how [the mutations] work, why they diminish or decrease susceptibility to certain drugs," says Götte. "When we understand the biochemical mechanism-why [resistance] happens-we can develop strategies to bypass it and develop better drugs."
Those strategies have to evolve out of treatment. It is common practice for physicians to screen for a strain's resistance before starting a course of treatment, since there are certain sections of the HIV genome that are known to be especially vulnerable to mutations. However, only the first 300 amino acids of a particular gene are usually tested, due to financial and time constraints. Götte's research suggests that it may be worthwhile to screen larger sections of the genome, because there may be hidden mutations in these areas.
Resistance was very common in the 1980s, when patients were treated with monotherapy, or a single drug. This created a higher likelihood of HIV developing drug resistance. Conditions have since improved with the advent of treatment which combines several drugs.
"The number of drugs is important, the combination of drugs is important, and the types of drugs are important… Within the last year we have [approved] two new classes of antiretroviral drugs and they can be used to treat those patients [with resistant strains from the eighties]," says Götte. "That is an enormous achievement in the field."
Patient compliance is also a problem in HIV treatment. Patients need to take the powerful drugs exactly as prescribed, despite any negative side effects. Introduction of new drugs is worthless if drugs are not taken properly, because improper use allows for the development of drug resistance.
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