Transmission of drug resistant HIV and its potential impact on mortality and treatment outcomes in resource-limited settings
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Transmission of drug resistant HIV and its potential impact on mortality and treatment outcomes in resource-limited settings. / Cambiano, Valentina; Bertagnolio, Silvia; Jordan, Michael R; Lundgren, Jens D; Phillips, Andrew.
In: The Journal of Infectious Diseases, Vol. 207 Suppl 2, 15.06.2013, p. S57-62.Research output: Contribution to journal › Journal article › Research
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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 -
ID: 93935010