Development of drug resistance mutations in patients on highly active antiretroviral therapy: Does competitive advantage drive evolution

Research output: Contribution to journalReview article

12 Scopus citations


Most physicians that treat individuals with HIV-1 disease are able to successfully suppress viral replication with the pharmacologic armamentarium available today. For the majority of patients this results in immune reconstitution and improved quality of life. However, a large fraction of these patients have transient elevations in their viral burden and even persistence of low-level viremia. In fact, many individuals whose viral load is suppressed to < 50 c/ml have evidence of low-level viral replication. The impact of low-level viremia and persistent viral replication is an area of significant study and interest owing to the potential for the development of drug resistance mutations. Here the fundamental question is whether and perhaps what factors provide a venue for the development of resistant virus. The concern is clearly the eventual progression of disease with the exhaustion of treatment options. The purpose of this review is to evaluate the current literature regarding the effect of low-level viremia on the development of drug resistance mutations. Herein, we discuss the impact of different levels of viral suppression on the development of mutations. In addition, we look at the role that resistance and fitness play in determining the survival of a breakthrough mutation within the background of drug.

Original languageEnglish (US)
Pages (from-to)68-74
Number of pages7
JournalAIDS Reviews
Issue number2
StatePublished - Apr 1 2007



  • HIV
  • Resistance mutations
  • Viral evolution
  • Viral fitness

ASJC Scopus subject areas

  • Virology
  • Immunology

Cite this