--------- AUGUST 200 I

FROM THE
EDITOR

Clinicians working in the field of HIV medicine welcome the

accelerated treatment access programmes that are

providing standard of care to HIV-infected individuals. This

has occurred as a result of the dramatic price reduction of

antiretroviral therapies. A vast amount of education is

required to bring health care professionals in our country

up to speed regarding the toxicities, drug interactions and

other complexities inherent in the wider use of

antiretroviral drugs. One of the major issues related to the

increasing use of these drugs is the question of viral

THE SOUTHERN AFRICAN JOURNAL Of HIV MEOICINE

resistance. The virus has an enormous capacity to mutate

and in the presence of sub-optimal drug concentrations

resistance may manifest with surprising rapidity. In this

issue the place of resistance testing is addressed by Or

Pierre Schoeman. In the management of patients, research

has shown that patients who have had access to resistance

testing have fared better than patients offered

management based on clinical judgement alone. It is

important to emphasise that the laboratory results should

be interpreted in consultation with the clinician, where

current clinical status, viral load, CD4 count and prior

treatment history are important in formulating future

treatment options.

The issue of drug resistance, however, goes beyond the

individual case and has rapidly become a global public

health issue. The incidence of transmission of drug-

resistant isolates has risen alarmingly; between 1999 and

2000, 5.8% of patients infected with HIV acquired strains

resistant to two classes of antiretroviral drugs, compared

with just 0.4% 5 years previously. One in 7 newly infected

persons in the USA now acquires a strain resistant to at

least one class of antiretroviral. Clearly the situation in

South Africa is not nearly as worrying. There is, however,

an urgent need to track resistance patterns in South Africa

and the establishment of a registry will facilitate this. This

will require a collaboration between academia, the public

sector and the private sector, where the most drug

resistance is currently occurring.

DES MARTIN
Editor, Southern African Journal of HIV Medicine
President Southern African HIV Clinicians Society

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