The new leader of the Mormon Church has insisted the religion is supportive of LGBT rights.
Russell M. Nelson, 93, was appointed head of the 16-million member church after the previous president, Thomas S. Monson died age 90.
Speaking for the first time as its president – a position which makes him a “prophet, seer and revelatory” – he said God loves people regardless of sexuality.
The Church of the Latter Day Saints is opposed to gay relationships and refuses to allow women to be priests.
Asked about LGBT rights, he said there were “challenges with the commandments of God, challenges to be worthy.”
He continued: “God loves his children and we love them and there’s a place for everyone. Regardless of his challenges.”
One of his chosen counsellors, Dallin H. Oaks added: “We’ve got the love of the Lord and the law of the Lord.”
Mr Nelson, a former heart surgeon, also told reporters he wanted to stick to the “traditional teachings” of Mormonism.
A rift has grown in the church over the issue of same-sex marriage in recent years, with members leaving due to its opposition.
Monson refused to let women become priests and excluded LGBT families to the point where many removed themselves from the Church entirely.
Diane Oviatt, who has a gay son, was one of the people who left over its resistance to same-sex marriage.
“You don’t leave Mormonism easily…there is shunning that happens,” she said on VICE News Tonight on HBO.
Diane became an activist to try and change attitudes within the Mormon community, co-founding a support group for mothers of LGBT children which she called Mama Dragons.
While the Church doesn’t condemn same-sex attraction, it does require celibacy from gay people.
(youtube/vicenews)
And in 2016, it introduced a hateful anti-LGBT policy which expelled same-sex couples and prevented their children from getting blessed or baptised until they were 18.
When it comes to members in general though, support for same-sex marriage has steadily risen since it was legalised in the US.
Many Mormons are confronting their crises of faith, with some of those who support LGBT rights seeking new tribes.
John Dehlin, who was excommunicated after raising questions about Mormonism on his podcast for those struggling with their faith, is a long-time supporter of LGBT youth.
He said there will be equality within the Church, but warned that it will take “20 or 30 years.”
The Elton John AIDS Foundation (EJAF), a leader in the global effort to end AIDS, today announced nearly $1.6 million in grants awarded in December 2017 to 26 organizations addressing the HIV/AIDS epidemic in critical and innovative ways. This final grant cycle brings EJAF’s total investments for 2017 to almost $9.5 million, and builds on the Foundation’s ongoing strategy to strengthen organizations doing essential work at local and national levels throughout the Americas and the Caribbean.
“The Elton John AIDS Foundation remains deeply committed to supporting organizations working to end the HIV/AIDS epidemic,” said EJAF Chairman David Furnish. “At a time when HIV transmission rates remain high for vulnerable populations, and funding for programs that advance the health and human rights of people affected by HIV/AIDS is being dramatically reduced, now is as critical time as ever to continue providing resources that help meet the needs of people affected by the disease.”
In this grant-making cycle, EJAF is continuing to prioritize marginalized populations who often face significant barriers to care and resources and have a uniquely heightened risk of contracting HIV: LGBT people, Black people, HIV-positive people in the criminal justice system, sex workers, and young people in the United States and Puerto Rico, Colombia, Jamaica, and Mexico.
“We believe it’s vital to invest in organizations and leaders working to address the unique needs of the communities they serve,” said EJAF Executive Director Scott Campbell. “Whether that means bolstering support for people who use drugs in Mexico or supporting state-level advocacy efforts in the U.S. South, aggressively investing in grassroots organizations is key to achieving an AIDS-free generation.”
Grants awarded as part of this cycle include:
Two new grants in Mexico that support HIV prevention, treatment access, and general health for people who use drugs in Tijuana, Mexico, and fund HIV-related peer support among women in Mexico City and Oaxaca.
One new grant in the Caribbean toward organizational development and capacity building for at-risk youth in Jamaica and the Dominican Republic.
Five new grants for state-level advocacy in Alabama, Florida, New Jersey, New York, and Tennessee to advance state policies and funding related to health care access and human rights.
Three new grants for national efforts, including a grant to the Harm Reduction Coalition to support harm reduction advocacy in multiple states. Grants will also go to the AIDS Institute and National Alliance of State and Territorial AIDS Directors for their work informing policy makers about the need and potential actions to sustain commitments for international and domestic health programs.
A complete list and descriptions of all 26 grants are posted at www.ejaf.org.
Research into the 2018 Best Workplaces in Technology, announced today by Great Place to Work and FORTUNE, reveals that tech companies struggling to create an inclusive workplace should foster an environment where each employee can be their own authentic self, regardless of their age, gender, race, or what they do within the organization.
Up to 30 percent of tech workers feel they can’t be themselves at work. That feeling reduces employee innovation, effort, and retention.
Employees at winning cultures are 6x more likely to recruit their friends on behalf of their company. Overall, best workplaces see half the voluntary turnover of peer companies. Employee recommendations and lower turnover help nurture a diverse workplace.
“Many companies offer great experiences such shark tank sessions and hackathons,” said Michael Bush, CEO of Great Place to Work. “But the best tech companies offer meaningful experiences relevant to their organization that resonate with every employee, creating a culture that welcomes all into every program, tapping into the unique genius of every person.”
Great Place to Work surveyed more than 79,000 employees across the information technology industry, assessing 50-plus elements of the workplace. These include trust in managers, compensation, fairness, camaraderie and workplace traits linked to innovation. The ranking accounted for the experiences of all employees including women, people of color, LGBT individuals, older team members and disabled employees.
Health insurer Aetna has agreed to pay $17 million to settle claims that it breached the privacy of thousands of customers who take HIV medications.
Attorneys for the plaintiffs announced the settlement Wednesday in Philadelphia.
Court documents say the Hartford, Conn.-based company sent a mailing in envelopes with large, clear display windows that revealed confidential HIV information. The mailing was sent to about 12,000 customers in at least 23 states.
The settlement requires court approval.
Aetna says the settlement is part of its effort to rectify what it called an “unfortunate incident.” The company also says it’s taking steps to prevent a similar mishap.
The Department of Education Office for Civil Rights has determined it does not have jurisdiction over responding to discrimination on the basis of gender identity. This approach has led the office to dismiss multiple complaints by transgender students.
The department’s Office for Civil Rights has told at least three transgender students that it is no longer required to handle matters related to alleged discrimination, HuffPost reported Tuesday.
“OCR determined we do not have subject matter jurisdiction over Allegation 1, insomuch as the alleged discriminatory conduct you described does not raise any prohibitive bases under the civil rights laws OCR enforces,” an agency letter dismissing one complaint read, according to HuffPost.
After rescinding the guidance, OCR officials told staffers to rely on “Title IX and its implementing regulations … in evaluating complaints of sex discrimination against individuals whether or not the individual is transgender.”
“Through their inaction, the Trump administration is attempting to write transgender students out of the protections of Title IX,” said James Esseks, director of the LGBT & HIV Project at the American Civil Liberties Union. “But the courts have concluded time and again that federal civil rights laws protect trans students from discrimination, including in the context of restroom and locker room use. The Trump administration may abdicate their obligation to trans students and their families, but the ACLU will not. We stand with transgender students, and will continue to fight for their right to an education free from discrimination.”
Friends of the famed researcher announced her death on social media yesterday.
Activist Peter Staley said on Facebook: “My greatest AIDS hero died a few hours ago. Dr. Mathilde Krim, founder of amfAR, warrior against homophobia and AIDS-related stigma, dedicated defender of science and public health, and mother-figure and mentor to countless activists, will leave a deep hole in the continued fight against AIDS — a fight she dedicated her life to. She as 91.”
In Los Angeles in 1985, Elizabeth Taylor and Dr. Michael Gottlieb cofounded the National AIDS Research Foundation to research for a cure and help people living with HIV/AIDS. At the same, Krim established the AIDS Medical Research Foundation. These two merged to become amfAR, cofounded by Krim and Gottlieb with Taylor as its international founding chairperson.
With the success of amfAR, and as people with HIV began to live longer, Taylor established the Elizabeth Taylor AIDS Foundation in 1991 to focus specifically on funding organizations that cared for individuals with HIV or AIDS. Taylor sold her wedding photos to People magazine for $1 million and used the money in its entirety to open the doors of ETAF. To date, more than 650 organizations in 33 countries have been helped through ETAF’s funding efforts.
amfAR’s bio on Krim:
Soon after the first cases of AIDS were reported in 1981, Dr. Mathilde Krim recognized that this new disease raised grave scientific and medical questions and that it might have important socio-political consequences. She dedicated herself to increasing the public’s awareness of AIDS and to a better understanding of its cause, its modes of transmission, and its epidemiologic pattern. Dr. Krim also became personally active in AIDS research through her work with interferons—natural substances now used in the treatment of certain viral and neoplastic diseases.
In April 1983, Dr. Krim founded the AIDS Medical Foundation (AMF), the first private organization concerned with fostering and supporting AIDS research. In 1985, AMF merged with a like-minded group based in California to form the American Foundation for AIDS Research (amfAR), which soon became the preeminent national nonprofit organization devoted to mobilizing the public’s generosity in support of trailblazing laboratory and clinical AIDS research, AIDS prevention, and the development of sound, AIDS-related public policies.
Dr. Krim received her Ph.D. from the University of Geneva, Switzerland, in 1953. From 1953 to 1959, she pursued research in cytogenetics and cancer-causing viruses at the Weizmann Institute of Science in Israel, where she was a member of the team that first developed a method for the prenatal determination of sex.
She moved to New York and joined the research staff of Cornell University Medical School following her marriage in 1958 to the late Arthur B. Krim, a New York attorney, then head of United Artists Motion Picture Company and later founder of Orion Pictures. Starting in 1962, Dr. Krim worked as a research scientist at the Sloan-Kettering Institute for Cancer Research and, from 1981–1985, she was the director of its Interferon Laboratory. She now holds the academic appointment of adjunct professor of Public Health and Management, Mailman School of Public Health, Columbia University.
Dr. Krim is amfAR’s founding chair and was, from 1990–2004, the chairman of the board. She holds 16 doctorates honoris causa and has received many other honors and distinctions. In August 2000 she was awarded the Presidential Medal of Freedom—the highest civilian honor in the United States.
A transgender woman who was burnt to death is the second to be killed in the US this year.
Viccky Gutierrez was brutally murdered on Wednesday (January 10) in the morning.
The Los Angeles Police Department has not confirmed that it was Gutierrez’s body that was found but a close founder of the deceased has said that it was her.
TransLatin@ Coalition founder Bamby Salcedo claimed that it was Gutierrez who died in a Facebook Live video.
Salcedo said that they know for sure the burned body is that of Gutierrez and they believe she was “brutally murdered”.
“It’s not just that she is gone—it is the way that she was murdered. She was brutally murdered. We believe that it was intentional. We believe it was premeditated,” she said in the Facebook video.
Salcedo explained that they believe she was killed before she was burnt based on the friend of Gutierrez’s who saw the victim the evening before.
“Her body was burned so we think she was murdered before they got there. It’s not confirmed – police are still investigating. But one of her closest friend, Cristy – who comes from the same small town in Honduras—had dinner with her that night and said she was okay.
“So there is a lot of speculation — we know the danger we experience every day. We think it’s possible she was killed before they burned her apartment. She was completely unrecognizable.
“People kept calling her cell phone and she didn’t answer. It was late at night and her neighbours were sleeping and no one heard her screaming. So my assumption is that she was dead or unconscious before she was burned. That’s why I’m 99% sure she was brutally murdered and burned to death,” Salcedo said.Salcedo knew the victim, who was from Honduras, from the TransLatin@ Coalition.
The victim was reportedly a sex worker and Salcedo believes that she may have faced issues because of this.
“There’s a strong possibility it came from work. It’s what we have to do. But we just don’t know. We asked the LAPD to check her cell phone but everything was burned,” Salcedo said.
She added that Gutierrez was “such a sweet girl”.
“She was our sister”.
LAPD spokesperson Officer Drake Madison confirmed that the LA Fire Department and a police division responded to a fire at 3.15 am on Wednesday in the Pico Union district.
The flames were contained to the attic of the block on South New Hampshire Boulevard.
One person was found dead inside and the death is being treated as suspicious, although no further information has been given as yet.
“This is a high priority case for us,” LAPD Det. Sharon Kim.
An autopsy and official identification are expected to be released by the end of the day.
A vigil of resistance will be held for Gutierrez on Friday, January 12 from 7:00p-10:00pm at 1660 Venice Blvd, LA 90006.
A GoFundMe page has been set up by Salcedo to pay for the funeral costs.
LAPD Det. Sharon Kim asks that anyone with information or tips call: 213-382-9470.
If the reports are confirmed, Gutierrez will be the second transgender woman killed in the US this year.
Christa Leigh was found wrapped in bedding, plastic sheeting and tar pooling in the basement of their home.
She had been stabbed a number of times, with the blood loss leading to her death.
She also had blunt force trauma to the head.
Christa Leigh was known for founding and running Miss Trans New England and Miss Trans America pageants.
An agreement has been reached in the case of a transgender student who was seeking access to the bathroom of his choice at his Wisconsin high school.
Ashton Whitaker, who has since graduated high school, sued Kenosha Unified School District over its policy of restricting transgender students to using separate bathrooms from their peers. A lower court in September, 2016 ordered the school district to stop enforcing the policy. The school district turned to the U.S. Seventh Circuit Court of Appeals, which also sided with Whitaker.
A three-judge panel said that Title IX of the Education Amendment of 1972, which bans sex discrimination in public schools, applies in the case, marking the first time that a federal appellate court took such a stance.
“A policy that requires an individual to use a bathroom that does not conform with his or her gender identity punishes that individual for his or her gender non-conformance, which in turn violates Title IX,” wrote Circuit Judge Ann Claire Williams in a 35-page ruling. “Providing a gender-neutral alternative is not sufficient to relieve the School District from liability, as it is the policy itself which violates the Act.”
The school district appealed the ruling to the U.S. Supreme Court. But as a condition of the settlement announced this week, which remains subject to court approval, the school district agreed to withdraw its petition before the high court.
If the settlement is approved by the court, it means that in Wisconsin, Illinois and Indiana, the three states the appeals court covers, public schools must allow transgender students access to restrooms consistent with their gender identity. It also means that the Supreme Court will not get to weigh in on the issue.
Whitaker said in a statement that he’s “deeply relieved” by the settlement.
“Winning this case was so empowering and made me feel like I can actually do something to help other trans youth live authentically,” Whitaker said. “My message to other trans kids is to respect themselves and accept themselves and love themselves. If someone’s telling you that you don’t deserve that, prove them wrong.”
Whitaker was represented by the San Francisco-based Transgender Law Center.
“KUSD’s discriminatory actions included banning Ash from using boys’ restrooms, invasively monitoring his restroom use, referring to him by female pronouns in front of other students, initially denying him the right to run for junior prom king, and forcing him to room by himself during a week-long orchestra camp,” the Transgender Law Center said in a statement. “To avoid punishment, Ash tried to avoid using the bathroom at school altogether, and suffered serious depression, anxiety, and other physical and educational harms as a result of the discrimination he faced.”
As part of the settlement, the school district must pay $800,000 to Whitaker and reasonable attorneys’ fees.
“This settlement sends a clear message that schools are responsible for treating transgender students fairly and equally, without exception,” Masen Davis, CEO of the LGBT group Freedom for All Americans, said in a statement.
California State Treasurer John Chiang Thursday officially rolled out CBIG.ca.gov, the California Business Incentives Gateway. The online gateway connects business owners and entrepreneurs to incentives to help them grow and create jobs.
“CBIG is open for business. California is launching its version of Amazon or Angie’s List, but instead of connecting people with products or services, we will be connecting businesses — ranging from local mom-and-pops to multinational corporations — with the economic incentives, permitting assistance, and employee training that they need to grow and prosper,” said Chiang. “Today, there are hundreds of incentives and opportunities for businesses just a click away, tomorrow there will be thousands. We are taking a page from the innovative marketplaces pioneered by California’s tech sector to propel not just business creation and expansion, but ultimately job, jobs, and more jobs.”
The CBIG site makes it easy for businesses expanding or locating in California to find and apply for incentives as part of a strategic business plan. Counties, cities and municipalities have been loading the site with incentives during a beta trial over the past year.
CBIG provides access to scores of incentives, including those overseen by the Treasurer, such as tax credits, loans and bond financing.
Incentives on CBIG include:
Sales tax exclusions
Training grants
Fee waivers
Permit assistance
Reduced utility rates
Employee recruitment
Among businesses already seeing the potential of using the CBIG portal is Aemerge RedPak Services. Aemerge converts problematic waste into clean energy. The company recently was awarded millions in tax-exempt bonds and a $3.1 million sales tax exclusion from the State Treasurer’s Office to build a state-of-the-art medical waste recycling processing plant in the City of Hesperia.
“The new business incentives gateway website created by the State Treasurer’s Office represents a new and useful tool to view many of the programs that we have used to aid in the expansion of our company and the construction of new facilities,” said Aemerge COO Landon Miller. “This financial assistance has allowed us to create more good-paying jobs right here in California.”
CBIG makes it simple for local, state and federal government agencies to post an incentive. Its user interface makes searching and applying for incentives akin to state-of-the-art online shopping experiences, like Amazon.com. Businesses can search by location or industry to find the most advantageous opportunities.
The number of incentives uploaded to the site has surpassed initial projections and is expected to accelerate as awareness for CBIG continues to grow.
If you’re living with HIV, you’ve likely heard about HIV drug resistance. Maybe your HIV provider has even talked to you about HIV drug resistance testing. But what is drug resistance? How common is it, should you be worried about it, and more importantly—what can you do to prevent it?
HIV drug resistance is a problem because it means that the type of HIV you have is “resistant” to, or isn’t affected by, a particular type of HIV medication. Drug resistance can limit the treatment options that will work for a person.
In this article, we provide a low-down on HIV drug resistance, including what it is and how you get tested for it. We also have advice from HIV clinicians on prevention and what to do if you do develop HIV drug resistance.
What is HIV drug resistance?
HIV medications work by preventing the virus from replicating (making copies of itself). When a particular strain of HIV is able to make copies of itself, even in the presence of a particular antiretroviral, we say that it is “drug resistant.”
HIV drug resistance isn’t a blanket condition. People living with HIV may have one or more drug-resistant mutations that make them less sensitive to one or more antiretrovirals. For example, if people have protease mutations, their HIV is resistant to protease inhibitors, meaning that a drug like darunavir (Prezista), a protease inhibitor, may not work for them. People with reverse transcriptase mutations may be resistant to a drug like emtricitabine/TDF (Truvada), a nucleoside reverse transcriptase inhibitor.
Because antiretrovirals in the same “class” (for instance two different types of NNRTIs) prevent HIV from replicating in the same way, if the virus becomes resistant to one drug within that class, it can become partially- or fully-resistant to all drugs within that class. For example, a person that develops HIV drug resistance to Prezista may also be resistant to atazanavir (Reyataz), because they are both protease inhibitors.
How bad is drug resistance? Is it something I should worry about?
“Mostly no major harm is done if someone develops or even acquires drug resistant HIV. Usually there are other meds that will work,” said David Alain Wohl, MD, a professor in the Division of Infectious Diseases at the University of North Carolina at Chapel Hill. “But with more resistance comes fewer second chances and less flexibility. That means we may have to use drugs that are harder to take or have more side effects. In rare but not unheard-of cases, people run out of options.”
Fortunately, newer HIV medications are less likely to produce drug resistance mutations than older HIV medications.
“Today’s HIV treatments work, really well. Once common, HIV drug resistance has become a quite uncommon thing for patients taking modern medications, even among those with less than perfect adherence,” Benjamin Young, MD, PhD, senior vice president and chief medical officer of the International Association of Providers in AIDS Care (IAPAC), told BETA.
In addition, some of the newer drugs today are particularly resistant to resistance.
“Drug resistance is particularly uncommon among people taking first-line HIV integrase inhibitors. This appears to be especially true for dolutegravir (Tivicay), where only a single case of treatment-emergent resistance has been reported during initial treatment. With today’s treatment options, dealing with drug resistant virus is easier, with potent and well-tolerated second-line options,” said Young.
How do people develop drug resistance?
Acquired HIV drug resistance can happen when a person has HIV that is replicating (making copies of itself), but is also taking a particular antiretroviral medication. HIV can mutate “around” that medication. This will result in HIV being resistant to the medications and those medications now being ineffective. In most studies, more than 70 – 80% of people with virological failure develop acquired HIV drug resistance. (Keep in mind that once a person becomes virally suppressed, these drug resistant mutations are no longer an issue.)
Although acquired drug resistance can occur if a person does not maintain good adherence to their HIV medications, sometimes the drugs themselves or a combination of how a person’s body reacts to the drug can also cause drug resistance. Even if you maintain perfect adherence, you may experience poor absorption. This means that the drugs don’t get absorbed by your body easily and aren’t preventing HIV from replicating, which can cause drug resistance.
Sometimes, drugs with less than optimal pharmacokinetics can cause drug resistance. This means that the drugs aren’t effective because they aren’t moving efficiently and sufficiently within your body.
Transmitted HIV drug resistance occurs when a person with HIV who has never been on treatment before acquires a strain of HIV that is already resistant to one or more HIV drugs. Transmitted drug resistance, as the name implies, occurs when a strain of HIV with drug-resistant mutations gets transmitted from a person living with HIV to an HIV-negative person. The prevalence of transmitted drug resistance is estimated to be between 12% and 24% among people living with HIV in the U.S.
Pretreatment HIV drug resistance can occur before treatment is even started. This may occur if a person is exposed to HIV medications when they become infected with HIV. For instance, if a women is taking drugs for prevention of mother-to-child HIV transmission or if a person is taking pre-exposure prophylaxis (PrEP), and then that person becomes infected with HIV, it is theoretically possible for that person to develop drug-resistance.
It is rare for drug resistant mutations to develop from a person taking PrEP (remember, there is no risk of drug resistance if HIV infection is prevented). One review of PrEP trials using the medication tenofovir disoproxil fumarate (TDF) found that 0.1% of approximately 9,000 people taking PrEP developed TDF or FTC drug resistant mutations. (Most of the people in these studies who acquired HIV and had drug resistant mutations already were HIV-positive when beginning PrEP, and therefore should not have been started on PrEP.)
How do you prevent HIV drug resistance?
People living with HIV can prevent drug resistance by remaining on treatment and adhering to their medications. With current HIV regimens, “adherence” commonly means taking medications once a day. Proper adherence can also include taking medications at a particular time of day, as well as with or without food, or on an empty stomach.
“We need to ensure that people who start treatment can stay on effective treatment, to prevent the emergence of HIV drug resistance,” said Gottfried Hirnschall, MD, MPH, director of the WHO’s HIV Department and Global Hepatitis Program.
“The best thing a person living with HIV can do to prevent drug resistance is to take their meds every day,” Wohl reiterated to BETA.
“The medications we have now to control HIV work incredibly well and are usually [taken] once a day. Plus, almost everyone tolerates them,” Wohl said.
Will I get drug resistance if I miss a dose?
In general, if you forget to take a dose, take your medications as soon as you realize you’ve missed the dose. However, if it’s almost time for your next dose, just wait until your next dose and continue your regular routine. Most important, do not take a double dose; you cannot make up for a missed dose that way. Although it’s important to take your HIV medications every day, you likely will not develop drug resistance from missing just one medication dose.
What if I keep missing doses?
Wohl explained that people most commonly miss antiretroviral medication doses because of events in their life that cause chaos or get in the way of pill-taking. It’s not because HIV antiretroviral pills are harder to take than other pills or because they cause more side effects.
“Be honest with [your] provider and tell them how often doses of meds are being missed and why. Asking for help with adherence earns you cred and lets [your] provider find ways to help. Pill boxes, setting a cell phone reminder, getting a family member or friend to help are all examples of interventions that could support medication taking,” Wohl said.
Your provider is there to help, and wants to see you do well. If you have any issues with your medications, it’s best to talk to your provider about it right away. If you’re uncomfortable with your current medication regimen, your provider might be able to work with you to find one that’s a better fit.
Wohl said that providers can also provide medications that are less likely to lead to drug-resistant HIV. “For some regimens, the virus has to do many more tricks to become mutated and therefore less susceptible to the drug. These can be used in those who may be [less adherent] with their meds,” said Wohl.
What is drug resistance testing?
There are two types of resistance tests: genotype testing and phenotype testing.
Genotype tests look for drug resistance mutations in relevant genes of the virus. Most genotype tests involve looking at the reverse transcriptase (RT), protease (PR), and integrase (IN) genes to see whether there are mutations that are known to be associated with drug resistance.
Because these genes are essential for HIV to take over cells and replicate, these are the same genes that the different classes of drugs take action against to stop HIV from replicating. That’s why, for instance, two of the drug classes are known as protease inhibitors and integrase inhibitors, because they inhibit the protease and integrase genes.
Phenotype tests measure the ability of a person’s virus to replicate in different concentrations of antiretroviral drugs. This test is typically done in individuals who have been on treatment and who have more complicated drug resistance patterns.
Genotype testing should be done for all people living with HIV before they start treatment. However, in some special cases, such as for pregnant women or people with very recent HIV infection, treatment should not be delayed while waiting for resistance testing results; treatment regimens can be changed once results come back.
How do you know if you’ve developed resistance?
The U.S. Department of Health and Human Services (DHHS) HIV treatment guidelines recommend HIV drug resistance testing when you first get into care, which is why HIV providers test people living with HIV for drug resistance before they start them on treatment. Your doctor should already know to give you a test before choosing a regimen, but if not, you should ask for it.
“It’s also important that baseline drug resistance testing is performed, especially for anyone starting on non-nucleoside containing regimens,” said Young. “That information can help guide decisions about what treatments to start,” he said.
It’s important for your HIV provider to know if you have or develop any drug resistance mutations, which is why it’s important for you to complete and follow-up with clinical and lab monitoring plans.
If you’re already on treatment, and you suddenly experience a detectable viral load, that doesn’t automatically mean your treatment regimen is failing or that you have drug resistance. This may be just a viral load blip, and continuing to take your HIV medications will bring your viral load back to undetectable. You and your HIV provider will make a decision based on your viral load and specific case.
Generally:
If your viral load goes above 1,000 copies/mL, drug resistance testing is recommended.
If your viral load goes above 500 copies/mL, but remains below 1,000 copies/mL, drug resistance testing may not be successful, but is still worth considering.
If your treatment regimen is not lowering your viral load as quickly as it should be, then the guidelines also recommend drug resistance testing.
What should people living with HIV do if they develop drug resistance for the first time?
If you develop drug resistance, Wohl advised taking the time to figure out if something went wrong, and to try to keep it from happening again.
“Was adherence difficult? Did drug supplies run out? Addressing the underlying cause while moving on to second-line treatment is important to minimize the risk of failure of the new regimen,” said Young.
“Get help from your clinic and your support network, if possible. If missing doses was the issue, it can be difficult to change the things that made it hard to take meds every day. But you have to try,” said Wohl.
“The good news is that today’s second-line antiretroviral treatments can be both very effective in suppressing resistant virus, and still be very well tolerated. Irrespective of what type of first-line treatment was used, second-line use of integrase inhibitors or boosted protease inhibitors can be successful,” Young added.
What about for people who have multi-drug resistance?
Fortunately, multi-drug resistance is uncommon, said Wohl. “And even in these folks, some meds may work,” he said. “Resistance is not always all or nothing. That means the resistant virus may still be affected by a med, just not as much. Combining meds with partial activity can work. Also, new drugs are still coming out that can work against drug-resistant strains.”
“The situation for patients with multi-drug resistance depends a lot on just how many drugs (or families of drugs) that the virus is resistant to,” explained Young. “For most people, the careful use of drug resistance tests can help sort out what medications the virus retains sensitivity to. If a regimen can be constructed with two or more active drugs, then viral suppression is likely—though adherence to the next round of treatment is perhaps even more critical than before.”
But what about some of the worst-case scenarios? Is there still hope if you exhaust most or all of the treatment options?
“For patients with only one, or no active drugs on the resistance tests, the situation is more serious. For these individuals, we’ll consider how drugs still in clinical trials may work. Indeed, several new classes of medications (maturation inhibitors, or monoclonal antibodies) may still suppress the virus,” said Young.
Takeaways for avoiding drug resistance
Before starting treatment, learn everything you can about your available treatment options. Knowing when and how often you need to take a regimen will help you make a better-informed decision about which regimen will work best for you.
Work with your provider to choose a strong treatment regimen. This goes along with learning everything you can about your treatment options. But sometimes choosing a potent regimen does a great deal to prevent drug resistance. Some of the newer drugs, particularly the integrase inhibitors, have a higher barrier to resistance and are more forgiving if you miss a dose.
Good treatment adherence is key in preventing drug resistance. Follow the dosing instructions carefully and take your medications as prescribed. That includes taking the right amount of pills, at the right time and with the right frequency. Don’t miss doses. Set a reminder or system that works best for you, so you will remember every day to take your pills. If you do miss a dose, take it as soon as you remember; but if it’s almost time for your next dose, simply wait for your next dose. Do not double dose.
Talk to your doctor and communicate honestly. Let them know if you’re having trouble taking your medications and work on ways to improve.
Monitor your health. How is the treatment working for you? How does it make you feel? Keep track of your lab numbers, including your viral load and CD4 count, and stay in constant communication with your HIV provider about your health.
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Warren Tong is a freelance health and science journalist, with an extensive background writing about HIV and hepatitis C. Follow Warren on Twitter: @warrentong https://twitter.com/warrentong.
HIV drug resistance is a problem because it means that the type of HIV you have is “resistant” to, or isn’t affected by, a particular type of HIV medication. Drug resistance can limit the treatment options that will work for a person.