Management of antiretroviral failure and resistance in developing countries

PURPOSE OF REVIEW: As scale-up of antiretroviral therapy in developing countries continues, an increasing number of patients developing antiretroviral failure and resistance are being identified. This review focuses on the identification and management of these complex patients in settings with limited antiretroviral drug options and resources. RECENT FINDINGS: The number of patients receiving second-line and salvage therapies remains lower than the number of patients who are eligible for these therapies. This situation is a result of delays in the recognition and management of antiretroviral failure caused by a lack of sensitive diagnostic techniques, and effective and tolerable alternative antiretroviral drugs. Alternative treatment options using currently available therapies in developing countries are suggested for the management of patients with antiretroviral failure and resistance. Strategies to enhance the durability of antiretroviral regimens to minimize the risk of failure are also discussed. SUMMARY: The development of antiretroviral failure and drug resistance among HIV-infected patients in developing countries is of increasing concern. Intensive efforts by HIV care and treatment programs are required to ensure the timely and effective diagnosis and management of these patients. Efforts to minimize the risk of failure are also needed given the significant cost and resource limitations in these settings.