Impact of genetic variation of HIV-1 on drug resistance development

HIV is a particularly diverse virus and can be classified into different types, groups and subtypes. Most of the current knowledge is based on HIV-1 subtype B, which is responsible for the first recognized epidemic, mainly spreading in the developed world, while the other subtypes are responsible for the major part of the pandemic, primarily in the developing world. Interest in the so-called 'non-B' subtypes is increasing, with treatment programs expanding to include Africa and Asia. According to several recent studies, differences exist between subtypes regarding drug susceptibility, resistance development and therapy response. Currently, conclusions are often based on too few patients or samples, and the use of different resistance assays and analysis methods makes it difficult to compare results. A common mistake is to pool subtypes and recombinants together as 'non-B subtypes', although they differ among each other as much as they differ from subtype B. Europe, with large epidemics of subtype B and several non-B subtypes in similar patient populations, is I well placed to take the lead in this research field.