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M-J Milloy, Wood E. www.thelancet.com/infection 2011; 11: 336–337

There is a stark difference in the prevalence of antiretroviral (ART) resistant HIV between wealthy and poor nations. This is as a consequence of the use of increasingly potent antiretroviral regimens (combination ART) and more tolerable antiretroviral regimens in wealthy nations. In addition, baseline resistance testing is carried out in wealthy countries, 'to guide the choice of first-line antiretroviral therapy'. Accordingly, the combination ART is 'tailored to the viral genotype to ensure full activity'. Because this strategy is not used in poor nations, in Zambia for example, only three years after the widespread distribution of antiretroviral drug regimens, 6% of individuals were infected with drug resistant HIV. It is suggested therefore, that in areas without resistance testing, treatment regimens should include a ritonavir-boosted protease inhibitor.