O112. International perspectives on adherence and resistance to HIV antiretroviral therapy

Excerpt

Public health debates about providing HIV antiretroviral therapy to impoverished HIV+ populations are based on the relationship between adherence and risk of drug resistance to HIV antiretroviral therapy. Early justifications for withholding antiretroviral therapy from marginalized domestic populations, such as drug users and the homeless, were mistaken for two reasons. First, levels of adherence in marginalized populations were not much different than the general HIV+ population, and second, early single protease-based antiretroviral therapy lead to drug resistance predominately in highly (80-95%) adherent individuals. In retrospect, HIV antiretroviral drug resistance during the first decade of effective therapy was not driven by poor adherence, but rather by the fact that early regimens were not potent enough to fully suppress the virus in patients who took most, if not all, of their medications. The introduction of more potent ritonavir-boosted protease inhibitor and non-nucleoside reverse transcriptase inhibitor regimens have shifted this relationship towards full viral suppression and cessation of drug resistance at high levels of adherence. …