Why HIV Drug Resistance Still Matters—And What We Can Do About It
By Andrew Zolopa, Treatment Medical Affairs Executive Director, Gilead Sciences and Professor of Medicine, Stanford University / Sponsored by Gilead Sciences / Intended for US audiences only
Even with decades of scientific research in HIV, a major challenge faced by people with HIV (PWH) continues to be HIV drug resistance.
HIV can change or mutate over time and HIV can develop something called a resistance mutation. When this happens, some HIV treatments may not work as well. Sometimes, HIV can already have a resistance mutation when it’s transmitted, or it can develop while someone is on treatment. But taking HIV treatment as your doctor prescribes can help lower the risk of resistance.
A major goal of HIV treatment is to become undetectable, which means there is so little virus in the blood that a lab test can’t measure it. Current research shows that taking HIV treatment as prescribed and getting to and staying undetectable prevents HIV from spreading through sex. This is also called U=U, or “Undetectable equals Untransmittable.” Reaching an undetectable viral load is a critical milestone for many people living with HIV, and by starting and staying on treatment, they can live longer and healthier lives with HIV as a chronic, manageable condition.
But here’s the challenge: treatment resistance can still stand in the way of getting to and staying undetectable, especially for those who have had to stop or restart care.
In the US in 2022, only about 65% of PWH were virally suppressed, which means having less than 200 copies of HIV per milliliter of blood. For those who do not stay on treatment — sometimes because of stigma and life challenges— the risk of resistance and illness increases. Resistance can mean the virus no longer responds to certain medicines, making treatment harder.
As a clinician and researcher, I’ve seen how resistance can affect how well some treatments work. In the early years of HIV treatment, resistance emerged as a major concern, influencing the decisions doctors made and shaping community conversations. Resistance isn’t talked about as much today, but that doesn’t mean it has gone away. Resistance is an especially real risk for people who experience care gaps, have trouble taking medicine regularly, or need to restart treatment. However, most people with HIV face some risk of developing resistance. That’s why it’s so important to talk with your healthcare provider about what resistance means and why taking your medicine as prescribed makes such a difference.
That’s why re-engaging people in care must go hand-in-hand with clear, supportive conversations about resistance, and making sure each person has access to medicines that fit their unique health needs. The good news is that science continues to evolve. Today, there are multiple treatment options available for PWH who have resistance, giving people more treatment options when restarting care. Your healthcare provider can help guide you to the option that’s right for you.
So, what does this mean if you’re living with HIV? It means that even if you’ve taken breaks from treatment, you can speak with your healthcare provider about restarting with a treatment that may be able to continue to work even if HIV has developed resistance to certain types of medicines. A medicine’s barrier to resistance refers to how well it can work even if the virus develops resistance to a mutation. We must not lose sight of the foundational goal: staying undetectable over time. That starts with taking your medication as prescribed. Your healthcare provider can help choose a treatment that has a high barrier to resistance—whether it’s your first regimen, you’re switching your regimen, or if you are restarting care.
The importance of awareness around topics like resistance, undetectability and starting and staying on treatment is what inspired Gilead Sciences to launch Choose U. Choose U is a new initiative that puts people first in conversations about HIV – encouraging them to prioritize their own health by having informed conversations with their providers and making choices that help lower the risk of resistance, help them achieve undetectability, and prioritize their health for the long term.
As an infectious disease specialist, my advice is simple: talk with your doctor about HIV treatment options that help support your long-term health. To learn more about HIV, visit ChooseUHIV.com.
Why HIV Drug Resistance Still Matters: US-UNBC-3469 10/25
