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 and Robert Gross
Affiliation: Johns Hopkins University, Bloomberg School of Public Health, 615 North Wolfe Street, Suite W5031, Baltimore, Maryland 21205, USA.
Keywords: HIV, antiretroviral therapy adherence, virologic failure, drug resistance, outcomes, resource-rich and resource-limited settings, flexibility, complexity, real-time cART adherence monitoring tool, morbidity and mortality, cART, protease inhibitor, test and treat, HIV prevention strategies
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.
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