9.1 Introduction

9.1.1 Introduction

This resource is an introduction to HIV drug resistance.

It is written for people who want to understand this aspect of HIV treatment (ART).

It was also developed as a training course for treatment advocates.

Although the subject sounds technical, this guide uses non-technical language.

Drug resistance can be very important. It can determine whether ART works well or whether it will fail. It determines your choice of HIV drugs.
Most people use ART for years without developing resistance.
However, if resistance develops, it stays with you for life.
Avoiding drug resistance makes sure you keep the widest choice of drugs.
The main principle behind resistance is simple.
If HIV continues to reproduce when on ART, resistance will develop.
Another way of saying this is:
If ART isn’t strong enough to stop HIV from reproducing, the virus will develop resistance to the ART – sometimes quickly, sometimes slowly.

9.1,2 Resistance on a personal level

If you are reading this guide for your own health, there may be more information than you expect or need.

We include lots of information that is not usually easy to find in one place. So it has more detail than other community guides about drug resistance. It was designed as a course based on reading one section each week.

Some of the really geeky stuff is in the appendices – but these are really for reference. Although we try to use non-technical language, when technical terms are important, we explain them. We also include a glossary.

Luckily, most people are able to use ART for many years without developing drug resistance. In most countries, drug resistance is also a smaller problem than when we first wrote this guide.

In the UK, less than 5% of people who have had an undetectable viral load for more than a year, are likely to develop resistance. This depends on continuing to take treatment. If resistance does develop, in many cases this is linked to difficulties with adherence.

The best way to avoid resistance is therefore to get into a good routine for taking your meds on time.

9.1.3 Questions about resistance

This guide started with a list of over 30 questions about drug resistance from people who are living with HIV.

Which drugs can someone use if they have resistance?
How are treatment choices made?
Can resistance be passed from mother to child?
Can someone develop resistance even with perfect adherence?
What is “wild-type” virus and what does it do?
When should you have a resistance test?
How expensive (or cheap) are resistance tests?
Are the tests always 100% accurate?
Is resistance inevitable?
What should I expect to hear back from my resistance test?
How does resistance affect me?
How can I avoid resistance?
Is resistance permanent?
What happens if I get resistance?

These are common questions. The guide was designed to answer these and others and to explain the science behind the answers.

Please see Appendix 1 – and they are also answered in the text through the guide.

If you have questions, please email the i-Base Q&A service and we will do our best to help:
questions@i-Base.org.uk

9.1.4 Course outline

Each section in this booklet was written as part of a course. Each section looks at a different aspect of resistance.

We start with basics. Each section describes a different aspect of drug resistance.

The resource needs you to be active.
Each section involves reading, taking your own notes, and responding to questions. Each section should take about 30-60 minutes. The additional material in appendices does not need to be learned by heart. These are references that will be referred to through the course.
We asked participants from the original course to ask questions and complete online evaluations.This involved sending at least one email back for each section. We included these questions as part of the training.

As well as learning, it is meant to be fun.

9.1.5 Learning objectives

By the end of the training you should have a good understanding of the following topics.

Key concepts: genetics, HIV structure and life cycle.
Basic mechanisms of how and why resistance to HIV drugs occurs.
How resistance is measured and how test results are interpreted.
The impact of resistance on HIV treatment and treatment options.
Treatment strategies for people with drug resistance.
How new drugs can overcome resistance.
Transmission of drug resistance.
When to use resistance testing.
Examples from research into drug resistance.

The training should help advocates advise on resistance research from a community perspective. For example, by working with researchers on local or national research studies.

It should help HIV positive people who want to understand this aspect of treatment in more detail.

1.1.6 Introductory reading

The following three short sections from the i-Base Introduction to Combination Therapy are included as background reading.

This information should help prompt questions that we cover later in the course.

1.1.7 Who produced this resource

This resource is section 9 of the i-Base advocacy training manual. It was mainly written and compiled by Simon Collins for HIV i-Base.

It is part of a copyright-free project that is available on the i-Base website to download in various formats, or to work online. As with other treatment information produced by i-Base we encourage translations into other languages.

Thanks also to an advisory group of community advocates, and to David Dunn and researchers at UK HIV Drug Resistance Database group for further comments.

Thanks to The Monument Trust for their support in funding the original publication.

1.1.8 Feedback

Each section in the online version of this guide includes a short online survey for feedback.

If you are reading this as a booklet in one go, there is a single feedback survey for the whole guide at this link:

surveymonkey.com/s/L8ZJM7P

Your feedback is important.

Thank you for helping us in this way.

Last updated: 1 January 2023.