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JAC Advance Access originally published online on July 28, 2004
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Journal of Antimicrobial Chemotherapy 2004 54(3):694; doi:10.1093/jac/dkh378
JAC vol.54 no.3 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved.

Correspondence

There are no paradoxes of adherence and drug resistance to HIV antiretroviral therapy

David A. Green*

On-Cue, Compliance Service, Hout Bay, Western Cape, South Africa

Keywords: adherence , HAART , HIV , AIDS

Sir,

The recent leading article by Bangsberg et al.1 is misleading in that it could lead readers to believe that there is increased resistance to highly active antiretroviral (ARV) therapy (HAART) with increased levels of adherence. In fact the authors make the case for increased resistance with increased adherence in ‘...cohorts of individuals treated with either sequential monotherapy or earlier, less potent three-drug regimens...’. This is precisely why the current modality of treatment is HAART. High levels of adherence to HAART are required in order to achieve adequate and sustained viral suppression and minimize the risk of resistance. To suggest otherwise is to muddy the waters and undermine efforts at achieving the unprecedented levels of compliance required for successful roll out of HAART.

Inadequate viral suppression (from using monotherapy or poorly selected combinations of ARVs) results in resistance. This is not paradoxical and would be predicted from our current knowledge of how resistance develops. The authors make an excellent case for careful selection of the ARV combinations to make up HAART. However, the article does mislead in that it could be read to suggest that lower levels of adherence with a properly chosen HAART regimen may be acceptable, or even desirable.

Footnotes

* Email: david{at}on-cue.co.za

References

1 . Bangsberg, D. R., Moss, A. R. & Deeks, S. G. (2004). Paradoxes of adherence and drug resistance to HIV antiretroviral chemotherapy. Journal of Antimicrobial Chemotherapy 53, 696–9.[Abstract/Free Full Text]


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This Article
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Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
54/3/694    most recent
dkh378v1
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