[Drug resistance in HIV infection]

Abstract

Background: Access to antiretroviral therapy has turned HIV infection into a chronic viral infection that requires lifelong therapy. Resistance to antiretroviral drugs remains an important limitation to long-term successful treatment. Testing of resistance and close clinical follow-up are important measures for choosing the right treatment

Material and methods: This review article is based on clinical experience and a selection of published papers on drug resistance in HIV.

Results: 26 drugs are currently available to inhibit specific steps in the lifecycle of HIV. Surveillance of primary resistance in newly diagnosed HIV patients has been implemented in Norway and other countries. Mutations associated with resistance were identified in 11.9 % of the analysed reverse transcriptase and protease sequences in the Norwegian material, which is in line with findings in European studies.

Interpretation: Failure to completely suppress viral replication allows for development of virus variants with varying degree of resistance. This does not only result in failed treatment, but increases the risk of further dissemination of resistant viruses (primary resistance). Access to and use of inhibitors of the integrase and the CCR5 co-receptor earlier during the course of HIV infection may lead to better control of virus replication and reduce development of drug resistance.