Adherence and Resistance to Antiretroviral Therapy

Dear Colleagues,

Since 1996, there has been a strong commitment to reach both therapeutic efficacy and avoidance of drug resistance in case of virologic failure. The development of modern drug classes has facilitated the life of those involved in HIV/AIDS treatment, particularly HIV-infected subjects. There is still a gap between the perfect efficacy and the maximal adherence and tolerability. All three aspects are interconnected. It is very clear that there is a distinct relationship between the degree of adherence to the antiretroviral medications and the virologic suppression. This was initially demonstrated by the antiretroviral regimen in general during the first highly active antiretroviral therapy (HAART) era and has been confirmed more recently with the combination including a non-nucleoside reverse transcriptase inhibitor (NNRTI). The optimal cut-off is, again, the 95% adherence. In both developing and developed countries there have been many demonstrations on how adherence affects clinical outcomes. Concerns related to non-adherence may be less of a barrier to initiation of modern HAART regimens. In the Italian Cohort of Naive for Antiretrovirals (ICONA), non-adherence was responsible of only 2% of treatment discontinuation in HIV-1 infected individuals starting their first-line ARV regimen after 2008 in Italy. HAART adherence levels for individuals who ever started therapy in British Columbia increased over time during 1996–2012: While only 37% of individuals had adherence levels >95% in 1996, which significantly increased to 71% for individuals by 2012. There is a tight interplay between adherence and virological suppression and drug resistance: A lower pill burden was significantly associated with both better adherence and virological suppression.

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• HIV
• Antiretroviral drugs
• Adherence
• Virological failure
• Reverse transcriptase
• Protease
• Integrase
• Co-receptors (CCR5 & CXCR4)
• Resistance
• Viral tropism
• Subtypes