Noting that the “[r]oll-out of antiretroviral treatment for HIV in sub-Saharan Africa has been accompanied by rising rates of drug resistance,” Raph Hamers, a global health research fellow at the Academic Medical Centre of the University of Amsterdam, and colleagues “call for improved patient management and the integration of population-based drug resistance surveillance into national treatment programs” in this BMJ analysis. “In sub-Saharan Africa, the region with the highest HIV/AIDS burden, high-level political commitment and substantial international funding have led to an unparalleled scale-up of access to treatment over the past eight years,” they write, adding, “However, little attention has been paid to the potential emergence and spread of drug-resistant HIV and its public health implications.”

The authors provide an overview of HIV drug resistance, discuss the importance of “identify[ing] patients in whom treatment is failing so that they can be switched promptly to second-line therapy,” highlight the need for “improved access to alternative drugs with different modes of action,” and argue that “drug resistance assessment should be routinely integrated into the national HIV treatment programs.” They conclude, “Without cumulative resistance surveillance data and commitment on the part of WHO, international funding agencies, and national governments to address programmatic challenges, emerging drug resistance has the potential to curb, and even reverse, further progress on breaking the HIV epidemic” (6/18).