Editorial Commentary: HIV Treatment Decisions and Transmitted Drug Resistance

Abstract

The first observation of the transmission of zidovudine-resistant HIV was reported by Erice et al. in 1993 [1]. Since then, investigators from North America and Europe have reported highly variable estimated prevalences of transmitted drug resistance [2–6]. These estimates range from ∼5% to ∼25%, and such studies are almost uniformly limited by their relatively small sample sizes, nonuniform resistance testing methodologies, and differences in study populations with respect to HIV-associated risk behaviors and geographic differences, which influence HIV subtype prevalence. None of these studies represents a true surveillance system that measures HIV drug resistance among individuals with primary HIV infection, but, rather, they represent convenience samples of high-risk people within the geographic region of interest, which ultimately limits the generalizability of the observations.