HIV resistance to antiviral drugs: public health implications.

The widespread occurrence of HIV strains resistant to antiviral drugs has given rise to a number of important concerns distinct from the obvious question of the relationship between drug resistance and treatment failure. A major issue is the extent to which drug-resistant viruses may be transmitted in primary infection via sexual or intravenous routes and how this relates to the relative fitness of such strains. It is also important to understand the potential role of effective antiviral therapy in the decrease of viral burden in both blood and sexual secretions, and the extent to which this may be compromised in individuals harboring resistant viruses. A related subject is the important role of patient adherence to antiviral therapy in achieving sustained reduction in viral load and preventing the emergence of drug resistance. These linked topics are tied to the central role of antiviral agents in the selection of mutant forms that can attain a replication advantage in the presence of drug.