This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (62)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Social Bookmarking   What's this?

Joel E. Gallant, MD, MPH

JAMA. 2000;283:1329-1334.

Highly active antiretroviral therapy has revolutionized the treatment of human immunodeficiency virus (HIV) infection, which can now be viewed as a chronic and manageable disease. However, HIV infection differs from other chronic diseases in that early treatment decisions can irrevocably alter the patient's response to future therapy. Despite the large number of approved antiretroviral agents, the number of sequential treatment regimens that will be effective for an individual patient is sharply limited by cross-resistance within the 3 drug classes.

Because of the complexity of antiretroviral therapy, clinicians prescribing it require considerable expertise. Treatment should be deferred until the patient has been educated about the importance of strict adherence and has demonstrated willingness and motivation to begin therapy. Drug regimens should be chosen that the patient can tolerate and adhere to, and the consequences of resistance should be considered before therapy is begun. When treatment fails, the timing and choice of subsequent therapy can be critical in determining the magnitude and durability of response. Resistance testing can help guide the clinician in the choice of therapy. In patients who have been treated with numerous antiretroviral agents, it may be impossible to achieve significant viral suppression. Therapy may still be beneficial for such patients, but it should be tolerable and should not increase resistance to drugs that may become available in the near future.

Drug resistance and treatment failure are not random events, but are the result of factors over which clinicians and their patients have some control. The treatment of drug-resistant patients is challenging; the best way to deal with resistance is to prevent it.

Author Affiliation: Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Md.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

March 8, 2000
JAMA. 2000;283(10):1361-1362.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Is natural conception a valid option for HIV-serodiscordant couples?
Barreiro et al.
Hum Reprod 2007;22:2353-2358.
ABSTRACT | FULL TEXT  

Pharmacokinetics of Saquinavir, Atazanavir, and Ritonavir in a Twice-Daily Boosted Double-Protease Inhibitor Regimen
von Hentig et al.
Antimicrob. Agents Chemother. 2007;51:1431-1439.
ABSTRACT | FULL TEXT  

Should ART be offered to HIV-serodiscordant and HIV-seroconcordant couples: an ethical discussion?
Zutlevics
Hum Reprod 2006;21:1956-1960.
ABSTRACT | FULL TEXT  

Adherence to trizivir and tenofovir as a simplified salvage regimen is associated with suppression of viraemia and a decreased cholesterol
Latham et al.
J Antimicrob Chemother 2005;56:186-189.
ABSTRACT | FULL TEXT  

Independent Evolution of Human Immunodeficiency Virus (HIV) Drug Resistance Mutations in Diverse Areas of the Brain in HIV-Infected Patients, with and without Dementia, on Antiretroviral Treatment
Smit et al.
J. Virol. 2004;78:10133-10148.
ABSTRACT | FULL TEXT  

Discrepancies between Protease Inhibitor Concentrations and Viral Load in Reservoirs and Sanctuary Sites in Human Immunodeficiency Virus-Infected Patients
Solas et al.
Antimicrob. Agents Chemother. 2003;47:238-243.
ABSTRACT | FULL TEXT  

HIV Resistance Testing: an Update
Aslanzadeh
Annals of Clinical & Laboratory Science 2002;32:406-413.
ABSTRACT | FULL TEXT  

Health and Federal Budgetary Effects of Increasing Access to Antiretroviral Medications for HIV by Expanding Medicaid
Kahn et al.
Am. J. Public Health 2001;91:1464-1473.
ABSTRACT | FULL TEXT  

Antiretroviral Resistance: Mechanisms, Detection and Clinical Implications
Sharma
Journal of Pharmacy Practice 2000;13:442-456.
ABSTRACT  

Multicenter Comparison of Roche COBAS AMPLICOR MONITOR Version 1.5, Organon Teknika NucliSens QT with Extractor, and Bayer Quantiplex Version 3.0 for Quantification of Human Immunodeficiency Virus Type 1 RNA in Plasma
Murphy et al.
J. Clin. Microbiol. 2000;38:4034-4041.
ABSTRACT | FULL TEXT  

HIV therapy: Managing resistance
Wodarz and Nowak
Proc. Natl. Acad. Sci. USA 2000;97:8193-8195.
FULL TEXT