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Testing for HIV-1 drug resistance is routine in many clinical settings, yet changing ART based on resistance testing does not necessarily lead to effective treatment. The assays used by clinical laboratories provide a consensus of the actively replicating viral population, and can miss drug-resistant variants constituting <50% of the population. Trials evaluating the clinical utility of drug resistance testing have not provided convincing evidence of clinical benefit. This apparent failure can be attributed to complex virus, host, and ARV interactions that also pose barriers to effective treatment.Adherence to prescribed ART is foremost among these, although variations in host pharmacokinetics and cross-resistance within ARV classes also pose significant obstacles. Novel assays and ARV may eventually change the approach to drug-resistance testing and improve the outcome of HIV-1 treatment. [ABSTRACT FROM AUTHOR]