HIV drug resistance: problems and perspectives

TL;DR

This paper reviews the current challenges and perspectives on HIV drug resistance, highlighting the impact of resistance on treatment efficacy and discussing recent developments in understanding resistance mechanisms and their implications.

Contribution

It provides a comprehensive overview of HIV drug resistance issues, including transmitted, acquired, and multi-class resistance, with insights into recent research and future perspectives.

Findings

Drug resistance remains a major threat in low-income countries.

Advances have slowed resistance evolution in some patients.

Resistance to newer drugs and prevention methods is emerging.

Abstract

Access to combination antiretroviral treatment (ART) has improved greatly over recent years. At the end of 2011, more than eight million HIV infected people were receiving antiretroviral therapy in low-income and middle-income countries. ART generally works well in keeping the virus suppressed and the patient healthy. However, treatment only works as long as the virus is not resistant against the drugs used. In the last decades, HIV treatments have become better and better at slowing down the evolution of drug resistance, so that some patients are treated for many years without having any resistance problems. However, for some patients, especially in low-income countries, drug resistance is still a serious threat to their health. This essay will review what is known about transmitted and acquired drug resistance, multi-class drug resistance, resistance to newer drugs, resistance due to treatment for the prevention of mother-to-child transmission, the role of minority variants (low-frequency drug-resistance mutations), and resistance due to pre-exposure prophylaxis.