From the McGill University AIDS Centre, Jewish General Hospital, Montreal, Quebec (Dr Wainberg), and the AIDS Program, Yale University School of Medicine, New Haven, Conn (Dr Friedland).
Widespread use of antiretroviral agents and increasing occurrence of
human immunodeficiency virus (HIV) strains resistant to these drugs have given
rise to a number of important issues. Some of these concerns are distinct
from the obvious question of the relationship between drug resistance and
treatment failure and have potentially widespread public health implications.
The relevant issues include but are not limited to the following:(1) frequency
with which drug-resistant virus may be transmitted via sexual, intravenous,
or mother-to-child routes; (2) ability of drug-resistant variants to be transmitted,
a question that relates, in part, to the relative fitness of such strains;
(3) effectiveness of antiviral therapy in diminishing viral burden in both
blood and genital secretions, and whether this may be compromised in persons
harboring resistant virus; and (4) importance of patient adherence to antiviral
therapy and its relationship to sustained reduction in viral load to minimize
the appearance in and transmission of drug-resistant virus from both blood
and genital secretions. Thus, prevention of both development of HIV drug resistance
as well as transmission of drug-resistant variants is a central issue of public
health importance. Unless this topic is appropriately addressed, the likelihood
is that drug-resistant variants of HIV, if able to successfully replicate,
will sustain the epidemic and limit the effectiveness of antiviral therapy.
Mark A. Wainberg, Gerald Friedland. Public Health Implications of Antiretroviral Therapy and HIV Drug Resistance. JAMA. 1998;279(24):1977–1983. doi:10.1001/jama.279.24.1977