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JAC Advance Access published online on March 24, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh162
© 2004 by The British Society for Antimicrobial Chemotherapy
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© 2004 The British Society for Antimicrobial Chemotherapy

Leading article

Paradoxes of adherence and drug resistance to HIV antiretroviral therapy

David R. Bangsberg 1 *, Andrew R. Moss 2 , and Steven G. Deeks 3

1 The Epidemiology and Prevention Interventions Center, San Francisco General Hospital, UCSF; The San Francisco General Hospital AIDS Program, UCSF;
2 The Department of Epidemiology and Biostatistics, San Francisco General Hospital, UCSF, 1001 Potrero Avenue, San Francisco, CA 94110, USA
3 The San Francisco General Hospital AIDS Program, UCSF;

* Corresponding author. E-mail: db{at}epi-center.ucsf.edu.

Abstract

Public health debates about providing HIV antiretroviral therapy to impoverished populations have centred on the relationship between adherence and risk of drug resistance. Recent data indicate that each antiretroviral therapeutic class has a unique adherence-resistance relationship. Resistance to single protease inhibitor therapy occurs most frequently at moderate to high levels of adherence, resistance to non-nucleoside reverse transcriptase inhibitor therapy occurs at low to moderate levels of adherence, and resistance to ritonavir-boosted protease inhibitor therapy is most likely to occur at middle ranges of adherence. These dynamic relationships should be considered in balancing the individual and public health benefits of therapy.

Keywords: resource-constrained countries, drug users, protease inhibitors, non-nucleoside reverse transcriptase inhibitors, public health
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