Knowledge-Based Avoidance of Drug-Resistant HIV Mutants

Currently in the United States, it is estimated to infect 3 to 5 million persons, is the leading cause of death in adults from 14 to 35, and is the nation's leading cause of productive years of life lost aggregated over all age groups. HIV is estimated to infect 40 to 50 million persons worldwide (CDC 1997). The high rate of HIV viral mutation both makes development of a vaccine difficult and results in rapid positive selection for drug-resistant mutant strains. Recent multidrug combination therapies are encouraging but in most cases ultimately fail because of the development of drug resistance (O'Brian et al. 1996). A general theory of HIV drug resistance still is not in hand, but a number of specific sequence mutations in the HIV genome have been described in the scientific literature and associated with increased resistance to certain drugs.