The World Health Organization's global strategy for prevention and assessment of HIV drug resistance

• Published in: Antiviral therapy Vol. 13 Suppl 2; no. 2_suppl; pp. 1 - 13
• Main Authors: Bennett, Diane E, Bertagnolio, Silvia, Sutherland, Donald, Gilks, Charles F
• Format: Journal Article
• Language: English
• Published: England 01.01.2008
• Subjects: Anti-Retroviral Agents - therapeutic use; Developing Countries; Drug Resistance, Viral - genetics; Genotype; Global Health; Health Care Surveys; Health Policy; HIV - genetics; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - transmission; HIV Infections - virology; Humans; International Cooperation; Molecular Diagnostic Techniques; Mutation; National Health Programs; Population Surveillance; Practice Guidelines as Topic; Program Development; Program Evaluation; Viral Load; World Health Organization
• ISSN: 1359-6535; 2040-2058
• DOI: 10.1177/135965350801302S03

Antiretroviral treatment (ART) for HIV is being scaled up rapidly in resource-limited countries. Treatment options are simplified and standardized, generally with one potent first-line regimen and one potent alternate first-line regimen recommended. Widespread HIV drug resistance (HIVDR) was initially feared, but reports from resource-limited countries suggest that initial ART programmes are as effective as in resource-rich countries, which should limit HIV drug resistance if programme effectiveness continues during scale-up. ART interruptions must be minimized to maintain viral suppression on the first-line regimen for as long as possible. Lack of availability of appropriate second-line drugs is a concern, as is the additional accumulation of resistance mutations in the absence of viral load testing to determine failure. The World Health Organization (WHO) recommends a minimum-resource strategy for prevention and assessment of HIVDR in resource-limited countries. The WHO's Global Network HIVResNet provides standardized tools, training, technical assistance, laboratory quality assurance, analysis of results and recommendations for guidelines and public health action. National strategies focus on assessments to guide immediate public health action to improve ART programme effectiveness in minimizing HIVDR and to guide regimen selection. Globally, WHO HIVResNet collects and analyses data to support evidence-based international policies and guidelines. Financial support is provided by major international organizations and technical support from HIVDR experts worldwide. As of December 2007, 25 countries were planning or implementing the strategy; seven countries report results in this supplement.