In this manner, HIV replication becomes the source of new viral strains and, ultimately, is the engine that drives the development of drug resistance. To avoid the development of resistance, we must stop viral replication. If treatment is effective and the person is adherent, the virus will be held in check. If the drugs are not adequately absorbed or the person is not sufficiently adherent, we will see viral replication and the emergence of HIV that is resistant to the drugs being used. The take-home message is that, to maintain potent antiviral activity, people must adhere to treatment.
Drug resistance is important for two reasons.
First, if a person's virus becomes resistant to a drug, then the treatment is no longer beneficial for him or her. But there is another reason to be concerned about resistance, and that is that a person who develops drug-resistant strains of HIV can pass that resistant virus on to others. Fortunately, we now have several key studies on adherence, and they tell a similar story. I'll briefly describe a few of them. This committee, along with the ACTG Patient Care Committee, surveyed 75 people taking combination therapy.