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14 - HIV drug resistance

Published online by Cambridge University Press:  23 December 2009

By
Frank Maldarelli
Edited by
Steven L. Zeichner  and
Jennifer S. Read
Frank Maldarelli
Affiliation:
HIV-1 Drug Resistance Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
Steven L. Zeichner
Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read
Affiliation:
National Institutes of Health, Bethesda, Maryland
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Summary

Introduction

One of the most challenging limitations of antiretroviral therapy is the emergence of drug resistant mutants of HIV, which occurs in 30%–40% of treated patients. For the individual, drug resistance renders antiretroviral therapy much less effective, resulting in the return of HIV viremia and disease progression. Resistant variants are transmitted when new HIV infections occur, and the spread of resistant HIV to newly infected individuals is a growing public health concern. The benefits of HIV resistance testing have been reported in several clinical trials; resistance testing is recommended in certain clinical situations in adult populations. Many questions remain however, and methods to study and analyze HIV drug resistance continue to evolve. Several excellent reviews on HIV drug resistance testing have recently been published [1–8].

Collections of drug resistance mutations are often depicted in tables (see Tables 14.1 and 14.2); such tables, although useful, do not depict degrees of resistance or complexities of interactions among mutations. Online compendia of mutations, frequently updated (e.g., hivdb.stanford.edu, hiv-web.lanl.gov (a sequence compendium of utility for researchers), www.hivresistanceweb.com, www.iasusa.org/resistance_mutations/index.html) provide additional information concerning antiretroviral resistance mutations.

Mechanisms of drug resistance

Studies of HIV replication suggest that HIV populations in vivo are characterized by high genetic diversity; as a result it is likely that some HIV drug resistance mutations are present even prior to the initiation of antiviral therapy. Initiation of antiretrovirals serves to suppress sensitive HIV and permit growth of resistant virus.

Type
Chapter
Information
Handbook of Pediatric HIV Care , pp. 397 - 414
Publisher: Cambridge University Press
Print publication year: 2006

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  • HIV drug resistance
    • By Frank Maldarelli, HIV-1 Drug Resistance Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.016
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  • HIV drug resistance
    • By Frank Maldarelli, HIV-1 Drug Resistance Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.016
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • HIV drug resistance
    • By Frank Maldarelli, HIV-1 Drug Resistance Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.016
Available formats
×