Clinical significance of antiretroviral resistance

R. T. D'Aquila*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Recent data from different lines of investigation support the clinical significance of antiretroviral resistance. Zidovudine (ZDV)-resistant viruses are transmissible. All of the early escapes from the suppression of virus replication afforded by monotherapy with larnivudune (3TC) and nonnucleoside RT inhibitors is attributable to replication of resistant virus, as is a portion of the early escape from ZVD suppression. Levels of circulating virus slowly increase during prolonged ZVD therapy commensurate with the incremental development of increasingly ZDV-resistant isolates. High level ZDV resistance predicts more rapid progression during therapy even after controlling for other pathogenetic factors. However, resistance is not the only pathogenetic mechanism operative during antiretroviral therapy. Some early escape from ZDV suppression appears due to resurgent replication of wilde-type virus, suggesting a role for pathogenetic mechanisms other than virus resistance. Quantitative assays of plasma HIV-1 RNA are likely to assess escape from antiviral suppression mediated by any mechanism and may predict clinical responses ire different treatment groups. The use of plasma RNA quantitation to assist therapeutic decision-making in an individual patient is promising. Implications of drug-resistant virus biology for therapeutic and monitoring strategies will be discussed.

Original languageEnglish (US)
Pages (from-to)217-229
Number of pages13
JournalMedecine Biologie Environnement
Volume23
Issue number2
StatePublished - Dec 1 1995

Keywords

  • Antiretroviral resistance
  • Combination therapy
  • Didanosine
  • HIV-1 reverse transcriptase
  • Lamivudine
  • Non-nucleoside reverse transcriptase inhibitors
  • Zidovudine

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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