Clinical Significance and Biologic Basis of HIV Drug Resistance
The availability of antiretrovirals worldwide has increased significantly in the last 10 years, such that approximately 50% of all HIV-infected persons are on antiretroviral therapy. Unfortunately, due to issues such as nonadherence and lack of availability of HIV RNA and resistance assays, the incidence of both drug-selected resistance mutations and transmitted drug resistance remains at unacceptably high levels. An understanding of basic principles of antiretroviral resistance, including specific drug-limiting and class-limiting mutations, is a useful first step in global efforts to extend the useful life of initial and subsequent antiretroviral regimens. In addition, a thorough understanding of the mechanisms by which drug-limiting mutations develop can help with the development of drugs that are either more resilient or have activity in the presence of previously selected mutations. This chapter should prove to be useful to both basic scientists and clinicians who deal with antiretroviral resistance issues on a frequent basis.
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