Hidden Drug Resistant HIV to Emerge in the Era of Universal Treatment Access in Southeast Asia

PLoS One

Matthew G. Law¹  David P. Wilson¹  Alexander Hoare²  Stephen J. Kerr²  David A. Cooper²  Praphan Phanuphak³  Kiat Ruxrungtham³  Jintanat Ananworanich³ 

[1]Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

[2]National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia

[3]The HIV Netherlands Australia Thailand Research Collaboration, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand

关键词: Antimicrobial resistance;    Drug therapy;    HIV epidemiology;    Antiretroviral therapy;    Viral load;    HIV;    Asia;    Therapeutic drug monitoring;   

DOI  :  10.1371/journal.pone.0010981

学科分类：医学（综合）

来源: Public Library of Science

【 摘 要 】

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.Methods and Findings 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.

【 授权许可】

CC BY