Antiretroviral Therapy Access and Drug Resistance Management

Antiretroviral therapy (ART) has transformed HIV from a fatal condition into a manageable chronic disease, yet equitable access and the prevention of drug resistance remain pressing global challenges. Access to ART depends on reliable supply chains, affordable pricing structures and robust health systems capable of accurate forecasting, procurement and distribution. Stock‐outs of medicines can lead to treatment interruptions, which not only jeopardise patient health but also promote the emergence of drug-resistant viral strains. Resistance management encompasses early detection of virological failure through viral load monitoring, prompt regimen adaptation and adherence support. Tailoring treatment guidelines to regional resistance patterns and ensuring the availability of second- and third-line therapies are critical to sustaining long-term viral suppression. International policies such as tiered pricing, patent pooling and pooled procurement have helped reduce costs and improve access in low- and middle-income settings, yet disparities persist. Surveillance of transmitted and acquired drug resistance informs national programme decisions and guides the development of novel antiretrovirals. Integrating community-based adherence interventions, decentralised care models and point-of-care diagnostics strengthens both access and resistance management. As treatment horizons expand to include long-acting agents and simplified regimens, coordinated efforts across policy, clinical practice and supply-chain management are essential to achieve sustainable control of the HIV epidemic.

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Antiretroviral Therapy Access and Drug Resistance Management publication trend

The graph below shows the total number of articles in antiretroviral therapy access and drug resistance management across all publications each year (not limited to Nature Index journals).

Technical terms

Antiretroviral Therapy (ART): A treatment regimen combining drugs that inhibit HIV replication to achieve and maintain viral suppression.

Viral Load: The quantity of HIV RNA in a patient’s blood, used to monitor treatment efficacy and detect virological failure.

Drug Resistance: The reduction in responsiveness of HIV strains to antiretroviral agents, often arising from incomplete adherence or suboptimal drug levels.

Stock-out: A period during which a healthcare facility lacks a required medicine or diagnostic test, risking treatment interruption.

Regimen: A prescribed combination of antiretroviral drugs used concurrently to treat HIV infection.

Adherence: The extent to which a patient follows the prescribed dosing schedule, critical for preventing resistance and sustaining viral suppression.

References

1. The 90 90 90 strategy to end the HIV Pandemic by 2030: Can the supply chain handle it?. Journal of the International AIDS Society (2016).
2. Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey. PLOS ONE (2019).
3. Monitoring HIV Drug Resistance Early Warning Indicators in Cameroon: A Study Following the Revised World Health Organization Recommendations. PLOS ONE (2015).
4. Intervening in global markets to improve access to HIV/AIDS treatment: an analysis of international policies and the dynamics of global antiretroviral medicines markets. Globalization and Health (2010).