Doctors in Japan warned of the rapid prevalence of drug-resistant HIV after 17 percent of HIV patients diagnosed at Nagoya National Hospital last year were found to have it. "It's only a matter of time before drug-resistant HIV spreads throughout the country," said Tsuguhiro Kaneda, chief of the center for immunity deficiency at the hospital, pointing to the sharp increase from 5 percent in 2001.

There are more than 2,600 AIDS patients in Japan, and about 5,300 people reportedly infected with HIV. Some estimates suggest the number of HIV patients could surge to 50,000 by 2010.

Drug-resistant HIV emerges after patients are treated with HIV drugs, and the virus mutates in response. The use of at least three drugs -- highly active antiretroviral therapy -- reduces the probability of resistance. However, problems with adherence can reduce the drugs' effectiveness. "If HIV-infected people who are taking drugs twice a day forget to take them three times a month there [is] a risk that the HIV could become drug resistant," said Kazuko Ikeda, who is in charge of medication support at Tokyo's International Medical Center of Japan. He said some people get tired of taking the drugs and some suffer side effects.

Nagoya's immunity deficiency center monitors whether patients are adhering to their drug regimens for six months after therapy begins, but few hospitals offer that service. The US CDC announced guidelines for medical institution workers with HIV patients, advising testing the patients for STDs to determine risk behavior, and offering lifestyle counseling.

Wataru Sugiura, an AIDS specialist at Japan's National Institute of Infectious Disease, called for wider use of a pretreatment test to select effective drugs for each HIV patient. Widely used in Europe, such tests examine possible gene mutations in HIV that could make it drug-resistant. But pretreatment testing is costly and therefore unlikely to see widespread use in Japan unless it is covered by health insurance.

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