Rationale and uses of a public HIV drug-resistance database
Seminar by Bob Shafer
The development of antiretroviral (ARV) combinations able to prevent the emergence of HIV-1 drug resistance was central to developing successful antiretroviral therapy (ART). The creation of national ART programs that administer ARV combinations in resource-limited regions has saved hundreds of thousands of lives and provided hope to millions of others. However, acquired and transmitted HIV-1 drug resistance loom as continuing obstacles to these successes. Patients infected with HIV-1 drug resistant viruses have fewer treatment options and are at increased risk of morbidity and mortality, particularly in resource-limited regions where choices for ART are limited and virological monitoring infrequent.
Comprehensive, accurate, and transparent HIV-1 drug resistance knowledge is essential for population-based monitoring of acquired and transmitted resistance in resource-limited regions, for guiding salvage ARV therapy in well-resourced regions, and for highlighting drug-development needs in both types of regions. However, the extensive variability of viruses that comprise the Group M HIV-1 pandemic, the high rate of HIV-1 mutation, and the large number of available ARVs and ARV combinations has made it difficult to quantify the extent of transmitted and acquired drug resistance, to optimally interpret HIV-1 genotypic resistance tests, and to identify the most relevant genotypic characteristics of emerging multi-drug resistant HIV-1 variants.