title: HIV treatment adherence, drug resistance, virologic failure: evolving concepts.
abstract: Poor adherence to combined antiretroviral therapy (cART) has been shown to be a major determinant of virologic failure, emergence of drug resistant virus, disease progression, hospitalizations, mortality, and health care costs. While high adherence levels can be achieved in both resource-rich and resource-limited settings following initiation of cART, long-term adherence remains a challenge regardless of available resources. Barriers to optimal adherence may originate from individual (biological, socio-cultural, behavioral), pharmacological, and societal factors. Although patients and providers should continuously strive for maximum adherence to cART, there is accumulating evidence that each class of antiretroviral therapy has specific adherence-drug resistance relationship characteristics allowing certain regimens more flexibility than others. There is not a universally accepted measure for cART adherence, since each method has distinct advantages and disadvantages including cost, complexity, accuracy, precision, intrusiveness and bias. Development of a real-time cART adherence monitoring tool will enable the development of novel, pre-emptive adherence-improving strategies. The application of these strategies may ultimately prove to be the most cost-effective method to reduce morbidity and mortality for the individual and decrease the likelihood of HIV transmission and emergence of resistance in the community.
authors.affiliation: Departments of International Health and Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. jnachega@jhsph.edu
authors.forename: Jean B
authors.initials: JB
authors.lastname: Nachega
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Marconi
authors.forename: Gert U
authors.initials: GU
authors.lastname: van Zyl
authors.forename: Edward M
authors.initials: EM
authors.lastname: Gardner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Preiser
authors.forename: Steven Y
authors.initials: SY
authors.lastname: Hong
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
authors.forename: Robert
authors.initials: R
authors.lastname: Gross
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017048:Health Care Costs; D006801:Humans; D055118:Medication Adherence
chemical_list: D019380:Anti-HIV Agents