HIV Antiretroviral Drug Resistance in Africa

Highly active antiretroviral therapy (HAART) has dramatically reduced mortality and morbidity in HIVinfected persons in developed countries. Although the use of HAART remains limited in Africa, there are global efforts to make available these drugs to several million HIV-infected persons on the continent. In this review we examine the impact of HIV genetic diversity on the occurrence of drug-resistance mutations among non-B subtypes, and discuss the implication of resistant strains in programs aimed at implementing antiretroviral treatment (ART) in Africa, with respect to factors that may favor the occurrence of treatment-acquired drugresistant viruses, ways to monitor for drug resistance, and strategies to limit its occurrence. We assert that antiretroviral drug resistance is an inevitable consequence when providing long-term treatment, and should not be seen as a limitation of providing antiretrovirals to patients in esource-poor settings, but rather a necessary challenge to be incorporated into the rational design of programs that provide ART in Africa.