The significance of minority drug-resistant quasispecies

Excerpt

The establishment of persistent infection and the emergence of drug-resistant mutants are major obstacles facing the eradication of HIV-1. It can be assumed that drug-resistant viruses, once acquired, persist in the host throughout life, at least as minor viral populations and may impair the success of antiretroviral therapy.

Antiretroviral therapy has led to a dramatic reduction in mortality and significantly improves the quality of life of HIV-1-infected patients [1,2]. However, side effects, the requirement for strict adherence, and the fact that antiretroviral therapy does not completely inhibit residual replication of HIV-1 can lead to therapy failure. In one large study, 38% of patients experienced virological failure within 6 years of starting first-line therapy, and at least 27% developed resistance to one or more antiretroviral drugs [3].

This chapter summarises the currently available diagnostic methods to detect and quantify minor viral populations of drug-resistant HIV-1 and possible implications of minority drug-resistant quasispecies for subsequent therapeutic strategies.