The 2012 southern African ARV drug resistance testing guidelines

Following the rapid scale-up of the programme for universal access to antiretroviral therapy (ART) in southern Africa, resistance to antiretroviral medications will occur. A detectable viral load must be treated as an emergency and should trigger intensive patient tracking and adherence counselling. In contrast to the developed world, the incidence of transmitted resistance is still low in most areas in the region. Therefore, in this consensus statement we do not recommend resistance testing in HIV-infected adults upon diagnosis or ART initiation. However, baseline resistance testing is recommended for children who have been exposed to ART for prevention of mother-to-child-transmission therapy and subsequently become HIV-infected. Resistance testing is also recommended after virological failure of first- and second-line ART regimens.