HIV Drug Resistance Surveillance Guidance – 2015 Update
(2015; 20 pages)


Unprecedented scale-up of antiretroviral therapy (ART) has been observed over the past decade: at the end of 2015, 16 million people were receiving ART in low- and middle-income countries. However, the emergence of HIV drug resistance (HIVDR) can compromise the effectiveness of antiretroviral drugs, thereby jeopardizing the efficacy of ART to further reduce HIV incidence and HIV-associated morbidity and mortality.

HIVDR emerges when HIV replicates in the presence of antiretroviral drugs. If HIVDR becomes widespread, the drugs used to treat HIV infection may become ineffective. To date, levels of HIVDR in countries scaling up ART remain manageable; however, they are slowly increasing. For example, in East Africa, resistance rates to non-nucleoside drugs (such as nevirapine and efavirenz) have recently been reported as above 10%.

Although new ART recommendations (“treat all”) and the scale-up of pre-exposure prophylaxis using antiretroviral drugs are likely to further increase levels of HIVDR, concerns about resistant virus should not preclude adoption of a treat-all approach. To minimize the emergence and spread of HIVDR, the World Health Organization (WHO) recommends HIV treatment scale-up be accompanied by measures to monitor and improve the quality of ART delivery and surveillance of HIVDR.

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