Antiretroviral therapy (ART) has converted HIV infection from an almost universally fatal illness to a chronic manageable disease. Adherence to therapy is essential for full viral suppression and optimal immune reconstitution.
If antiretroviral (ARV) drug levels are suboptimal, the risk of developing ARV drug resistance is high due to the high rate of HIV replication and the lack of proofreading capacity in the viral reverse transcriptase enzyme. Continuation of a failing ART regimen can affect both the treated individual and the community, as resistant viral strains can be transmitted to other persons.
Resistance can be minimised by uninterrupted supply of medication, scientifically sound prescribing practices, long-term adherence support, viral load (VL) monitoring, and rapid responses to demonstrated virological failure with timeous changes of therapy. The Southern African HIV Clinicians Society developed consensus guidelines for HIV resistance testing that consider international best practice and the financial constraints encountered in southern Africa.
The guidelines, presented here, are based on the levels of resistance in the community as reported in the 2012 World Health Organization (WHO) HIV drug resistance report. The North American and British resistance testing guidelines, although ideal, are not affordable nor applicable in most southern African situations. These guidelines are aimed at southern African clinicians who manage individuals with HIV infection in both the private and public sectors in our region.