Treatment training manual

Resistance 1: Introduction

1.1 Introduction

This is an introduction to HIV drug resistance.

It is written for people who want to understand this aspect of their treatment.

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

Although the subject sounds technical, this guide is written in mainly non-technical language.

  • Drug resistance is important. It determines whether your treatment will work and whether it will fail. It determines which drugs you can use.
  • Most people use HIV treatment for years without developing resistance.
  • However, if resistance develops, it stays with you for life. Avoiding resistance makes sure you keep the widest choice of drugs.
  • The main principle behind resistance is simple. If an organism (i.e. a virus) continues to reproduce in the presence of a drug, resistance will develop.

1.2 Resistance on a personal level

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

One of the aims of the resource is to collect and explain information that is not usually easy to find in one place. So has more detail than most community guides to drug resistance. It was designed as a course based on reading one section each week. Take time to understand each section.

However, if you like to know more about this geeky stuff, more technical information is included in the appendices. We use non-technical language throughout but when technical terms are important, we explain them. We also include a glossary.

Luckily, most people are able to use HIV treatments for many years without developing drug resistance. This is important.

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.

1.3 Questions about resistance

This guide started with a list of over 30 questions about resistance from a group of HIV-positive people.

  • 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 questions that lots of people have. The guide was designed to work through the science behind the answers.

These and other questions are answered in Appendix 1 and they are also answered in the text through the guide.

If you have question after reading this resource, please email the i-Base Q&A service and we will do our best to help:

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.

Most people do not have a medical background, so we start with basics. Each section describes a different aspect of drug resistance.

  • The resource needs you to active participate.
  • 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.

1.5 Learning objectives

By the end of the training you should have an understanding of:

  • 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.

1.6 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.

1.7 Who produced this resource

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

This booklet is one section of the i-Base training manual for advocates. This resource 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.

This resource was original developed through a series of workshops with UK advocates. 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 this publication.

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:

Your feedback is important.

Thank you for helping us in this way.

Last updated: 1 September 2014.