HIV infects and destroys cells that fight germs in our bodies. The medicines used to prevent the multiplication of HIV in our bodies are called antiretrovirals. There are different types of antiretrovirals, each of them targeting a different part of the virus. To prevent the multiplication of HIV, in a substantial way, a combination of antiretrovirals is used at the same time (combination therapy). The goal of combination therapy is to reduce the amount of virus in our bodies to a very low level and quickly too, so that those cells in our bodies that fight disease are no longer killed by HIV; and are produced in good number and quality to do their work. Also, when the amount of virus in our bodies is small, the chance of transmitting the virus to others is also low. As a result, treatment for HIV is now considered as an important tool for prevention. One major challenge to the outcome of antiretroviral therapy is the emergence of HIV that is resistant to treatment, that is drug resistance. When HIV is no longer destroyed by a combination of antiretrovirals, then the virus is not controlled in our bodies. This also means the treatment has failed. Therefore, another combination needs to be decided upon, after finding out why the initial combination failed. Alternative combination therapies are, many times, not easily accessible, have more side effects, and are more expensive. HIV develops resistance by making changes to sections of its gene that lead to ineffectiveness of a drug that had an effect on those sections.
Our roles to prevent the development of HIV drug resistance
Research has shown that poor adherence to treatment is one of the major contributors to the development of HIV drug resistance. Other contributors include how our bodies breakdown the medicines, availability, and accessibility. Poor adherence is when an individual does not take medicines as prescribed, and this can be due to psycho-social factors. These include the mental state of the individual and how society relates to those who are HIV infected. Individuals and communities can help people on HIV treatment to reduce the chance of drug resistance development. We know that HIV treatment is long-term, so we can support our friends and relatives by encouraging them to stay on treatment and remind them to get refills, we should not discriminate against those with HIV at home and at the workplace, we should be sensitive to the challenges they may have such as decisions for family, education, and getting employed and staying on the job, or starting their own business. In short, we should be buddies to those on HIV treatment so that we can provide the social and environmental support they need to prevent the development of drug resistance, get cheaper treatment, not endure more severe side effects from alternative drugs, and live near-normal lives.
Resistance to HIV treatment is of global concern and it is an aspect of Antimicrobial resistance. You can read more about the relationship between adherence, HIV drug resistance, and viral suppression here https://pubmed.ncbi.nlm.nih.gov/33407664/
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