Title: Principles of HIV drug resistance for clinical management in South Africa
Authors: Stott K, Michel J, de Oliveira T.
Journal: HIV Nursing Matters,3(4):46-51 (2012)


The rapid scale-up of antiretroviral therapy (ART) during the past decade has led to dramatic reductions in HIVrelated morbidity and mortality. Efforts are now focused on maintaining virological suppression of patients on first line ART, detecting treatment failure and switching to second-line regimens where necessary.

A major threat to sustaining the positive impacts of ART is the increasing issue of drug resistance. Drug resistance may be primary (transmitted), whereby a person is infected by a strain of HIV that is not fully susceptible to antiretroviral medications (ARVs), or secondary (acquired), whereby a person develops resistance to ARVs over time. In South Africa, the level of primary resistance has been below 5% for the last decade and so this article will focus on the more pressing problem of secondary resistance.

In Southern Africa, routine viral-load monitoring is recommended to identify treatment failure but it is often not done with sufficient frequency, nor reacted to appropriately. There can be a reluctance to switch patients to second-line therapy, in spite of clear guidelines. This is in part because of a lack of certainty regarding the reason for treatment failure ? whether it is due to poor patient adherence, the development of drug resistance, or a combination of these issues. Nonetheless, patients who continue taking a failing ART regimen are at risk of developing resistance to those medications. This article reviews the South African guidelines for viral load monitoring and regimen switch and introduces basic concepts of drug resistance for nurses and health care workers. The information presented here is useful to practitioners throughout Southern Africa as most HIV epidemics in the region are dominated by the same HIV subtype (HIV-1 subtype C), and drug resistance develops by similar mechanisms.

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Citation: Stott K, Michel J, de Oliveira T. Principles of HIV drug resistance for clinical management in South Africa HIV Nursing Matters,3(4):46-51 (2012).