HIV treatment scale-up in Africa: The impact of drug resistance

Abstract

The availability of antiretroviral therapy (ART) to individuals infected with HIV in many African countries has greatly increased since 2004, as result of coordinated efforts of funding agencies and individual governments in rolling out HIV care and treatment. As the numbers of individuals receiving ART rises, the long-term clinical outcomes of ART among patients on treatment, needs to be further understood. In many resource-limited countries, the data on patterns of HIV resistance to antiretroviral drugs and the effect of HIV subtype diversity on resistance remains limited. Patients’ social economic situations and deficiencies in health systems could promote non-adherence that facilitates the development of drug resistance. Here we explore available data on HIV-1 resistance to ART in Africa, in relation to the drug regimens used, HIV-1 subtype diversity and its implication on drug resistance. We specifically examine reported HIV resistance associated with treatment, transmitted resistance, and prevention of mother-to-child transmission programs. Finally, we identify specific measures both in terms of research and public health efforts to contain and prevent drug resistance development in patients on treatment.