n CME : Your SA Journal of CPD - Antiretroviral resistance : main article
|Article Title||Antiretroviral resistance : main article|
|© Publisher:||Health and Medical Publishing Group (HMPG)|
|Journal||CME : Your SA Journal of CPD|
|Publication Date||May 2005|
|Pages||230 - 237|
|Keyword(s)||Adherence, Antiretroviral therapy, Drug regimens, Drug resistance, Mechanisms of resitance, Resistance mutations and Salvage therapy|
The prevention of resistance is the single most important way in which the long-term efficacy of HAART can be assured. This is best done by optimising adherence. <br>Adherence rates of 70 - 90% are most likely to select for resistance. <br>When there is virological failure on an NNRTI-containing regimen assume class resistance to the NNRTIs. <br>When there is virological failure on a 3TC-containing regimen assume 3TC resistance. If a first-line regimen containing D4T or AZT has failed for 6 months or less, significant resistance to these drugs is unlikely. <br>An antiretroviral regimen should be changed if the viral load continues to rebound despite optimising adherence. A change should never be made on the basis of one reading alone. <br>If a patient is left on a failing regimen then there is a risk of developing resistance to those drugs in the regimen with a high genetic barrier (e.g. AZT) and cross resistance. This compromises later options.
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