title: Hidden drug resistant HIV to emerge in the era of universal treatment access in Southeast Asia.
abstract: BACKGROUND
  Universal access to first-line antiretroviral therapy (ART) for HIV infection is becoming more of a reality in most low and middle income countries in Asia. However, second-line therapies are relatively scarce.
  
  
  RESULTS
  We developed a mathematical model of an HIV epidemic in a Southeast Asian setting and used it to forecast the impact of treatment plans, without second-line options, on the potential degree of acquisition and transmission of drug resistant HIV strains. We show that after 10 years of universal treatment access, up to 20% of treatment-naïve individuals with HIV may have drug-resistant strains but it depends on the relative fitness of viral strains.
  
  
  CONCLUSIONS
  If viral load testing of people on ART is carried out on a yearly basis and virological failure leads to effective second-line therapy, then transmitted drug resistance could be reduced by 80%. Greater efforts are required for minimizing first-line failure, to detect virological failure earlier, and to procure access to second-line therapies.
authors.affiliation: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hoare
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kerr
authors.forename: Kiat
authors.initials: K
authors.lastname: Ruxrungtham
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Law
authors.forename: David A
authors.initials: DA
authors.lastname: Cooper
authors.forename: Praphan
authors.initials: P
authors.lastname: Phanuphak
authors.forename: David P
authors.initials: DP
authors.lastname: Wilson
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001210:Asia, Southeastern; D024882:Drug Resistance, Viral; D006678:HIV / Q000187:drug effects*; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D006297:Health Services Accessibility; D006801:Humans; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents