Concept note: Surveillance of HIV drug resistance in adults receiving ART (Acquired HIV Drug Resistance); 2014
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HIV Drug Resistance emerges when HIV replicates in the presence of antiretroviral drugs. If HIV drug resistance becomes widespread, the drugs currently used to treat HIV infection may become ineffective. To date, levels of HIV Drug Resistance in countries scaling up ART remain manageable. However, resistance is slowly increasing: in East Africa, resistance rates of 10% to non-nucleoside drugs (such as nevirapine and efavirenz) have been recently described. To maximize the long-term effectiveness of first-line ART regimens, and ensure the sustainability of ART programmes, it is essential to minimize the further spread of HIV drug resistance. Even in settings with optimal ART programme management, some degree of HIVDR is expected to emerge in populations on ART and some HIVDR is expected to be transmitted to previously uninfected individuals. Therefore, WHO recommends that HIV treatment scale-up should always be accompanied by a robust assessment of drug resistance emergence and transmission. WHO’s HIVDR Monitoring and Surveillance Strategy is composed of five key elements: WHO’s HIVDR Monitoring and Surveillance Strategy is a critical component of the public health approach to ART delivery. By obtaining population-level data on HIVDR in different populations, its various elements can inform programmelevel decision making regarding, for example, optimal first and second lines, for both children and adults. Management of treatment failure (i.e. what to do when a patient fails a particular regimen) is addressed in the guidance note on ART. This document describes methods to assess HIVDR in adult populations on ART (surveillance of acquired HIVDR). |