HIV drug-resistant strains as epidemiologic sentinels.
Observed declines in drug resistance to nucleoside reverse transcriptase inhibitors among persons recently infected with HIV-1 in monitored subpopulations can be interpreted as a positive sign and lead public health officials to decrease efforts towards HIV prevention. By means of a mathematical model, we identified 3 processes that can account for the observed decline: increase in high-risk behavior, decrease in proportion of acutely infected persons whose conditions are treated, and change in treatment efficacy. These processes, singly or in combination, can lead to increases or decreases in disease and drug-resistance prevalence in the general population. We discuss the most appropriate public health response under each scenario and emphasize how further data collection and analyses are required to more reliably evaluate the observed time trends and the relative importance of forces shaping the epidemic. Our study highlights how drug resistance markers can be used as epidemiologic sentinels to devise public health solutions.
Sánchez
María S
MS
University of California, Berkeley, California 94720, USA. msanchez@nature.berkeley.edu
Grant
Robert M
RM
Porco
Travis C
TC
Getz
Wayne M
WM
D019380:Anti-HIV Agents / Q000494:pharmacology; D023241:Antiretroviral Therapy, Highly Active; D024882:Drug Resistance, Viral; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008954:Models, Biological; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology; D018571:Sentinel Surveillance
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors