AIDS is a huge challenge for global public health. Nowadays, the most effective treatment is antiretroviral therapy(ART), which can effectively suppress the viral load in the body and prolong the asymptomatic incubation period of infected people. With the wide clinical application of ART, drug pressure has changed the survival environment of HIV. This article takes whether ART changes the evolutionary trajectory of HIV as the core research question, and selects the United States, which has complete medical resources and a high ART coverage rate, and Yaounde, Cameroon, which has scarce resources and diverse subtypes of virus strains, as the comparative research areas. By integrating research methods from multiple disciplines such as genetics, clinical medicine, public health, and history, and combining existing literature research data, this paper analyzes the occurrence probability and transmission characteristics of drug-resistant mutations under different regulatory conditions. After a literature review, it was found that the degree of virus genetic variation in infected individuals who strictly follow medical advice to suppress the virus is extremely low. Patients with poor medication compliance and intermittent medication are more likely to develop drug-resistant strains. This article predicts that under the pressure of drugs, the evolution direction of HIV may gradually shift towards stronger drug resistance. Social factors such as regional economic level, drug accessibility, and public health policies have further exacerbated the evolutionary differentiation of HIV in different regions. Studying the evolution of HIV under ART intervention can have a favorable impact on global AIDS prevention and control.