Determinants of HIV drug resistance and public health implications in low- and middle-income countries.
Global scale-up of antiretroviral therapy (ART) in low- and middle-income countries (LMICs) is an unprecedented public health achievement. With planned efforts of expanded ART access including earlier treatment initiation and the use of antiretroviral (ARV) drugs for prophylaxis, increasing levels of HIV drug resistance (HIVDR) are expected.Several factors may lead to selection and transmission of significant HIVDR in LMICs, which will lead to decreased population-level efficacy of standard first- and second-line ART regimens. These factors include low genetic barrier of some ARVs to resistance development, drug-drug interactions, inappropriate prescribing practices, interruption of drug supply, poor retention in care and lack of routine viral load monitoring.To maximize long-term effectiveness of available ARVs, policy makers and programme managers in LMICs should routinely monitor programme factors associated with emergence and transmission of HIVDR and implement routine HIVDR surveillance following standardized methods. When surveillance results suggest the need for action, specific public health interventions must be taken to adjust ART programme functioning to minimize further emergence and transmission of HIVDR.In this paper, we review ARV drug, HIV, patient and programme-related determinants of HIVDR. Additionally, we summarize the World Health Orgnization's global HIVDR surveillance and prevention strategy and describe resulting public health and policy implications.
HIV Department, World Health Organization, Geneva, Switzerland. bertagnolios@who.int
Silvia
S
Bertagnolio
Andrea
A
De Luca
Marco
M
Vitoria
Shaffiq
S
Essajee
Martina
M
Penazzato
Steven Y
SY
Hong
Craig
C
McClure
Chris
C
Duncombe
Michael R
MR
Jordan
D000288:Administrative Personnel / Q000458:organization & administration; D044966:Anti-Retroviral Agents / Q000191:economics / Q000494:pharmacology; D003906:Developing Countries; D024882:Drug Resistance, Viral; D006678:HIV / Q000472:pathogenicity*; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000821:virology; D006801:Humans; D007182:Income; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D010349:Patient Compliance; D011159:Population Surveillance / Q000379:methods; D011634:Public Health / Q000331:legislation & jurisprudence*; D019562:Viral Load; D014944:World Health Organization / Q000458:organization & administration
D044966:Anti-Retroviral Agents