Transmitted HIV drug resistance in Asia

PURPOSE OF REVIEW: Surveillance for transmitted HIV drug resistance is essential to assessing the longer term sustainability and durability of first-line antiretroviral therapy (ART). Increases in pre-ART resistance would compromise the ability to achieve optimal and durable treatment outcomes using currently recommended antiretrovirals. RECENT FINDINGS: In the Asia region, many countries have conducted studies of transmitted resistance among recently HIV-infected and pre-ART patients. Data vary by methodology and resistance interpretation systems. Studies in some high-income settings have shown stabilizing or declining rates (e.g. Taiwan, Hong Kong), and increasing rates in others (e.g. Japan). In low-income and middle-income Asian countries, resistance has primarily been reported to be below WHO thresholds for moderate resistance (i.e. <5%). However, studies have identified an increased risk of resistance associated with male-to-male sex and/or higher rates among cohorts of MSM. Some countries still lack systematically collected transmitted resistance data. SUMMARY: To date, there does not appear to be a need for baseline resistance testing in most Asian settings for which there are data. However, MSM appear to be at higher risk of transmitted resistance and may benefit from enhanced resistance assessments and prevention interventions.