HIV treatment adherence, drug resistance, virologic failure: Evolving concepts

Jean B. Nachega, Vincent C. Marconi, Gert U. van Zyl, Edward M. Gardner, Wolfgang Preiser, Steven Y. Hong, Edward J. Mills, Robert Gross

Research output: Contribution to journalArticlepeer-review

Abstract

Poor adherence to combined antiretroviral therapy (cART) has been shown to be a major determinant of virologic failure, emergence of drug resistant virus, disease progression, hospitalizations, mortality, and health care costs. While high adherence levels can be achieved in both resource-rich and resource-limited settings following initiation of cART, long-term adherence remains a challenge regardless of available resources. Barriers to optimal adherence may originate from individual (biological, socio-cultural, behavioral), pharmacological, and societal factors. Although patients and providers should continuously strive for maximum adherence to cART, there is accumulating evidence that each class of antiretroviral therapy has specific adherence-drug resistance relationship characteristics allowing certain regimens more flexibility than others. There is not a universally accepted measure for cART adherence, since each method has distinct advantages and disadvantages including cost, complexity, accuracy, precision, intrusiveness and bias. Development of a real-time cART adherence monitoring tool will enable the development of novel, pre-emptive adherence-improving strategies. The application of these strategies may ultimately prove to be the most cost-effective method to reduce morbidity and mortality for the individual and decrease the likelihood of HIV transmission and emergence of resistance in the community.

Original languageEnglish (US)
Pages (from-to)167-174
Number of pages8
JournalInfectious Disorders - Drug Targets
Volume11
Issue number2
DOIs
StatePublished - 2011

Keywords

  • Antiretroviral therapy adherence
  • Drug resistance
  • HIV
  • Outcomes
  • Virologic failure

ASJC Scopus subject areas

  • Molecular Medicine
  • Pharmacology
  • Microbiology (medical)

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