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Large-scale
Surveillance for Detecting Transmitted Drug Resistance in Africa
is Unnecessary for the Next Decade
The
U.S. Government has pledged to spend $15 billion in Africa
and the Caribbean on AIDS. A central focus
of this plan is to provide antiretroviral
treatment (ART)
to millions of people in these areas.
In
the present study study, published in the current issue of AIDS
(January 3, 2005),
investigators evaluate whether the plan
to rollout ART in Africa is likely to generate an epidemic of drug-resistant strains of
HIV.
Biomathematicians
at UCSF, UCLA and the Department of Public Health in San Francisco
review what has occurred as a result of high usage of ART in developed
countries in terms of changes in risky behavior, and the emergence
and transmission of
drug-resistant HIV.
They
also review how mathematical models have been used to predict the
evolution of drug-resistant HIV epidemics. They then show how models
can be used to predict the likely impact of the ART rollout on the
evolution of drug-resistant HIV in Africa.
At
currently planned levels of treatment coverage, the researchers
predict that (over the next decade) in Africa:
(1)
The impact of ART on reducing HIV
transmission
(and prevalence) is likely to be undetectable (unless accompanied
by substantial changes in behavior);
(2)
The transmission rate of drug-resistant HIV will be below the WHO
surveillance threshold of 5%; and
(3)
The majority of cases of drug-resistant HIV that will occur will
be due to acquired (and not transmitted) resistance.
The
authors conclude, “For the next decade, large-scale surveillance
for detecting transmitted resistance in Africa is unnecessary.”
“Instead,
we recommend that patients should be closely monitored for acquired
resistance, and sentinel surveillance
(in a few urban centers) should be used to monitor transmitted
resistance.”
01/12/05
Reference
S
Blower and others. The antiretroviral rollout and drug-resistant
HIV in Africa: insights from empirical data and theoretical models.
AIDS 19(1): 1-14, January 3, 2005.
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