Despite the potency of current antiretrovirals, some patients continue to struggle with the management of the treatment of HIV due to drug resistance-associated mutations. The underlying causes of these developments are usually drug adherence and drug availability as well as the economic affordability of those potent drugs in low to middle-income countries as well as in some industrialised countries. Viral replication, despite therapy, varies by region from 5 to 28. Non-adherence includes a variety of behaviours with different clinical implications. Addressing non-adherence and choosing new regimens based on a strategic vision may aid overall treatment strategies in the future. Areas covered: The authors review the literature derived from Embase, MEDLINE and the main international congresses on transmitted and selected drug resistance to HIV therapeutics. They also consider the pharmacological aspects of antiretroviral therapy including the genetic barrier, convenience, potency, drug-drug interactions and tolerability are discuss prospective randomized or observational clinical trials on salvage therapy. Expert opinion: Preventive intervention is the most efficient way to reduce the selection and transmission of drug-resistant mutations. While subjects with no current available options may benefit from new compounds (ibalizumab and fostemsavir), strategies should be implemented to spare as many patients as possible from drug resistance.
Keywords: HIV; adherence; antiretroviral; interactions; resistance; strategic.