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[Editor’s note: This is the second in a series of posts covering topics related to drug resistance, including causes, effects, what is being done to fight drug resistance, and what needs to be done to limit the harm caused by drug-resistant pathogens. The first post is available here.]

The failure of antiretroviral therapy and the appearance of drug-resistant HIV strains continue to hinder efforts to keep HIV-positive individuals healthy. Unfortunately, the tests needed for early detection of antiretroviral therapy failure and drug resistance are expensive and not widely available in many countries with a high HIV prevalence. But the provision of such tests may benefit from an unusual source: old shipping containers.

Immunological and viral load testing are necessary to slow the emergence and spread of drug-resistant HIV strains. A recent meta-analysis published in The Lancet Infectious Diseases revealed that patients whose viral loads were monitored frequently (at 3-month intervals) were less likely to harbor drug-resistant HIV viruses at the time of virological failure than patients who were monitored less frequently or not at all. (Virological failure occurs when drugs are no longer able to suppress HIV replication and viral loads increase. Patients with viral loads of 1000 viral RNA copies per milliliter of blood or higher are considered to have experienced virological failure.)

Numerous studies have shown that resistant HIV viruses can be transmitted, causing some newly infected individuals to harbor HIV viruses resistant to antiretrovirals even before beginning treatment. The possibility of transmission of resistant viruses makes the expansion of viral load testing even more important — monitoring the viral loads of patients on antiretroviral therapy (ART) not only protects the patient from the harmful effects of virological failure and the emergence of drug resistant strains but it also protects the patient’s sexual partners (and the partner’s partners, and so on) from drug-resistant HIV. Read more