Antiretroviral medication adherence and the development of class-specific antiretroviral resistance

Edward M. Gardner, William J. Burman, John F. Steiner, Peter L. Anderson, David R. Bangsberg

Research output: Contribution to journalReview articlepeer-review

113 Scopus citations


OBJECTIVE:: To assess the association between antiretroviral adherence and the development of class-specific antiretroviral medication resistance. DESIGN AND METHODS:: Literature and conference abstract review of studies assessing the association between adherence to antiretroviral therapy and the development of antiretroviral medication resistance. RESULTS:: Factors that determine class-specific adherence-resistance relationships include antiretroviral regimen potency, viral fitness or, more specifically, the interplay between the fold-change in resistance and fold-change in fitness caused by drug resistance mutations, and the genetic barrier to antiretroviral resistance. During multidrug therapy, differential drug exposure increases the likelihood of developing resistance. In addition, antiretroviral medications with higher potency and higher genetic barriers to resistance decrease the incidence of resistance for companion antiretroviral medications at all adherence levels. CONCLUSION:: Knowledge of class-specific adherence-resistance relationships may help clinicians and patients tailor therapy to match individual patterns of adherence in order to minimize the development of resistance at failure. In addition, this information may guide the selection of optimal drug combinations and regimen sequences to improve the durability of antiretroviral therapy.

Original languageEnglish (US)
Pages (from-to)1035-1046
Number of pages12
Issue number9
StatePublished - Jun 1 2009
Externally publishedYes


  • Adherence
  • Antiretroviral resistance
  • Antiretroviral therapy
  • Genetic barrier to resistance
  • HIV
  • Potency
  • Replication capacity

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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