title: Transmission of drug resistant HIV and its potential impact on mortality and treatment outcomes in resource-limited settings.
abstract: 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.
authors.affiliation: University College London, London, United Kingdom. v.cambiano@ucl.ac.uk
authors.forename: Valentina
authors.initials: V
authors.lastname: Cambiano
authors.forename: Silvia
authors.initials: S
authors.lastname: Bertagnolio
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jordan
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D005838:Genotype; D005843:Geography; D006678:HIV / Q000187:drug effects / Q000235:genetics / Q000502:physiology*; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality / Q000821:virology*; D006295:Health Resources / Q000191:economics; D006801:Humans; D008962:Models, Theoretical; D009154:Mutation; D011159:Population Surveillance; D011203:Poverty; D015995:Prevalence; D011634:Public Health; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014944:World Health Organization
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV; antiretroviral therapy; mathematical model; mortality; resource-limited settings; transmitted drug resistance