Minor-drug-resistant HIV populations and treatment failure

Abstract

Treatment efficacy in those infected with HIV is eventually compromised by the development of resistance to antiretroviral drugs. To delay resistance in patients it is critical to better understand drug-resistance mechanisms and to accurately detect drug-resistant mutations prior to treatment. Minor-drug-resistant viruses are present in chronically infected patients, treatment-failure patients and those recently infected with resistant viruses through transmission. They are often present at levels below 20%, therefore conventional genotypic and phenotypic assays cannot detect them. Accumulating data indicate that minor-resistant viruses that are present before treatment can lead to drug resistance and poor treatment responses in patients. Detailed characterization of such minor-resistant populations using highly sensitive assays may have a profound impact on the treatment of HIV-infected individuals.