2 : Emergence of Human Immunodeficiency Virus Drug Resistance

Abstract:

The global pandemic of human immunodeficiency virus (HIV) infection represents a prime example of an emerging infection. The HIV pandemic has wreaked the majority of its havoc in the developing world, whereas drug-resistant HIV has been a problem among the more privileged economies. It was learned that the use of protease inhibitors as monotherapy or when added to an ongoing regimen was substandard practice, and patients failed with resistant virus. This was followed by another discovery that analogous to tuberculous chemotherapy, prescribing an optimal regimen without the education and support system to encourage patient adherence is no accomplishment and may lead to multiple-drug resistance. One significant difference between tuberculosis and HIV is that the former can be cured. The levels are highest in primary infection, which may be the most infectious period. The genetic barrier to viral escape will have to be raised in using combinations that require multiple mutations and incompatable mutations. The pharmacologic aspects of chemotherapy needs improvement, as many of the protease inhibitors that have relatively short half-lives give trough levels that are really borderline or suboptimal. Drug levels in the various tissue compartments that may represent pharmacologic sanctuaries will have to be attained. It has been learned from multiply resistant tuberculosis that the natural history resembled untreated tuberculosis, especially in the immunosuppressed.