Drug resistance and adherence to HIV/AIDS antiretroviral treatment: against a double standard between the north and the south.
Here we review the available evidence on adherence to highly active antiretroviral therapy (HAART) and its relationship with the risk of the dissemination of HIV-resistant viral strains in both developed and developing countries. We argue that referring to these issues of resistance and adherence to withhold or delay access to HAART in developing countries implicitly imposes a double standard of thinking that is unacceptable. Scaling-up access to HAART to succeed in low-resource settings, however, requires the long-term monitoring of adherence as well as the clarification of the complex trade-offs between minimizing the costs of therapeutic regimens and minimizing the risks of non-adherence and resistance.
University of the Mediterranean, INSERM Research Unit 379, Marseilles, France. moatti@marseille.inserm.fr
Jean Paul
JP
Moatti
Bruno
B
Spire
Michel
M
Kazatchkine
D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D003365:Costs and Cost Analysis; D019049:Developed Countries; D003906:Developing Countries; D024921:Drug Resistance, Multiple, Viral; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D015438:Health Behavior; D006801:Humans; D010349:Patient Compliance; D012307:Risk Factors