Hidden drug resistant HIV to emerge in the era of universal treatment access in Southeast Asia.

National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia.
PLoS ONE (Impact Factor: 3.53). 06/2010; 5(6):e10981. DOI: 10.1371/journal.pone.0010981
Source: PubMed

ABSTRACT 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.
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.
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.

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