TY - JOUR

T1 - Transmission of drug resistant HIV and its potential impact on mortality and treatment outcomes in resource-limited settings

AU - Cambiano, Valentina

AU - Bertagnolio, Silvia

AU - Jordan, Michael R

AU - Lundgren, Jens D

AU - Phillips, Andrew

PY - 2013/6/15

Y1 - 2013/6/15

N2 - Scale-up of antiretroviral therapy in low- and middle-income countries has been achieved by using a public health approach that involved national standard regimens and clinical monitoring in settings where laboratory infrastructure was not available. This strategy potentially allows for long periods of unrecognized viral failure, during which drug-resistant virus can be transmitted and this could compromise the long-term effectiveness of currently available first-line regimens. In response to this concern, the World Health Organization recommends population-based surveys to detect whether the prevalence of resistance in ART-naive people is reaching alerting levels. Whereas adherence counseling has to be an integral component of any treatment program, it is still unclear which threshold of transmitted drug resistance (TDR) should trigger additional targeted public health actions and which action is the most cost-effective. Mathematical models can contribute to answer these questions. In order to estimate the potential long-term impact of TDR on mortality in people on ART we used the Synthesis transmission model. TDR is predicted to have potentially significant impact on future HIV mortality. It is critical to remain vigilant over transmission of drug-resistant HIV.

AB - Scale-up of antiretroviral therapy in low- and middle-income countries has been achieved by using a public health approach that involved national standard regimens and clinical monitoring in settings where laboratory infrastructure was not available. This strategy potentially allows for long periods of unrecognized viral failure, during which drug-resistant virus can be transmitted and this could compromise the long-term effectiveness of currently available first-line regimens. In response to this concern, the World Health Organization recommends population-based surveys to detect whether the prevalence of resistance in ART-naive people is reaching alerting levels. Whereas adherence counseling has to be an integral component of any treatment program, it is still unclear which threshold of transmitted drug resistance (TDR) should trigger additional targeted public health actions and which action is the most cost-effective. Mathematical models can contribute to answer these questions. In order to estimate the potential long-term impact of TDR on mortality in people on ART we used the Synthesis transmission model. TDR is predicted to have potentially significant impact on future HIV mortality. It is critical to remain vigilant over transmission of drug-resistant HIV.

KW - Anti-Retroviral Agents

KW - Cost-Benefit Analysis

KW - Developing Countries

KW - Drug Resistance, Viral

KW - Drug Therapy, Combination

KW - Genotype

KW - Geography

KW - HIV

KW - HIV Infections

KW - Health Resources

KW - Humans

KW - Models, Theoretical

KW - Mutation

KW - Population Surveillance

KW - Poverty

KW - Prevalence

KW - Public Health

KW - Time Factors

KW - Treatment Outcome

KW - Viral Load

KW - World Health Organization

U2 - 10.1093/infdis/jit111

DO - 10.1093/infdis/jit111

M3 - Journal article

C2 - 23687290

VL - 207 Suppl 2

SP - S57-62

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

SN - 0022-1899

ER -