The global hiv drug resistance surveillance network who. Surveillance of transmitted hiv drug resistance in. Only with a standard list of mutations is it possible to compare the prevalence of transmitted resistance from different times and regions and facilitate metaanalyses of surveillance data collected by different groups at different times. A steady increase in hiv drug resistance hivdr has been demonstrated. Mhs molecular hiv surveillance mhs is a cdcfunded surveillance initiative that incorporates hiv genotype testing specifically sequencing the reverse transcriptase rt, protease pr, and integrase regions of the pol gene of hiv into routine electronic laboratory test reporting. This fact sheet contains information on the hiv surveillance systems that dhap currently supports. Circulating drug resistant hiv 1 variants in antiretroviralnaive populations are on the rise in regions where access to antiretroviral therapy art has recently been scaled up, particularly in lowincome and middleincome countries lmics. A statetransition model of hiv infection was adapted to simulate. To date, levels of hiv drug resistance hivdr in countries scaling up art remain manageable. Hiv 1 diversity was analyzed using the dnastar software and drug resistance mutations were analyzed using the stanford university hiv drug resistance database. A compendium of published hiv1 rt and pr sequences from more than 30,000 persons in more than 200 worldwide studies. Piloting a surveillance system for hiv drug resistance in the. To support effective use of art and prevent spread of hivdr, monitoring is essential. Pdf hiv1 drugresistance surveillance among treatment.
Aim we piloted a surveillance system for transmitted hivdr to assess the feasibility of implementation at the european level. These drug resistance surveillance projects funded by the centers for disease control and prevention cdc have operated under several names, including arvdrt antiretroviral arv drug resistance testing, varhs variant, atypical and resistant hiv surveillance and mhs molecular hiv surveillance. National hiv drug resistance prevention, monitoring and. A secondgeneration hiv sentinel surveillance among men who have sex with men msm, regardless of prior history of hiv screening, serostatus, or treatment, was conducted in peru in 2002. Hiv1 drug resistance and resistance testing sciencedirect. In order to monitor the transmission of drug resistant strains and the subtype profile in brazil, a national network for drug resistance surveillance hiv bresnet in the drug naive population was established. Affordable hiv drugresistance testing for monitoring of antiretroviral therapy in. Clutter3, bradley hare4, orna mor5, maxime grude6, neil parkin7, michael r. In europe, north america, and brazil, the prevalence of hiv 1 drug resistance is 5%15% in newly diagnosed individuals and 10%25% in treatmentexperienced patients 7, 8.
The global hiv drug resistance surveillance network will track the drug susceptibility of hiv in a rapidly moving epidemic, to provide information necessary to. In this vignette, we illustrate the analysis of a real nonsimulated data set, including all the preprocessing steps. To examine the value of resistance surveillance in influencing recommendations toward effective and costeffective sequencing of art regimens. Surveillance systems statistics center hivaids cdc. Surveillance of hiv and tuberculosis drug resistance article in the lancet 3669484. Resistance mutations were interpreted using the stanford hiv database algorithm and the who hivdr surveillance mutations sdrm. Pineda, 4 dixiana flores, 5 roxana motino, 5 victor umanzor. Sentinel testing programs for hiv drug resistance in resourcelimited settings can inform policy on antiretroviral therapy art and drug sequencing. A time trend analysis was conducted using r software to look for any. Hiv1 drug resistance and resistance testing request pdf. Integrase strand transfer inhibitor instiresistance. Hiv 1 drug resistance can be transmitted when patients carry hiv 1 variants with drms.
Surveillance is conducted in rotating, annual cycles in three different populations at increased risk for hiv. Drug resistance mutations for surveillance of transmitted hiv1. A softwareguided hiv1 drug resistance test for lowresource. Nextgeneration human immunodeficiency virus sequencing. Piloting a surveillance system for hiv drug resistance in. Incidence the prevalence of hiv aids includes all people living with hiv and aids, regardless of when they acquired the infection. Surveillance of hiv1 pol transmitted drug resistance in acutely and. Only with a standard list of mutations is it possible to compare the prevalence of transmitted resistance from different times and regions and facilitate metaanalyses of surveillance data. The consequences of hivdr include treatment failure and further spread of drug resistant hiv. This also projected that the overall hiv epidemic in nepal is on a decline. Programs that monitor local, national, and regional levels of transmitted hiv1 drug resistance inform treatment guidelines and provide. Hiv drug resistance surveillance in africa recently, a sharp increase of hiv drug resistance was reported for africa.
Integrase strand transfer inhibitor insti resistance mutations for the surveillance of transmitted hiv 1 drug resistance philip l. For example, many countries with high hiv prevalence perform hiv sero surveillance in populations of women attending antenatal clinics anc. World health organization protocol for surveillance of. Brazilian network for hiv drug resistance surveillance. Surveillance of hiv drug resistance in children newly diagnosed with hiv by early infant diagnosis. In 2003, cdc created nhbs to conduct behavioral surveillance among persons at high risk for hiv infection. Instructional software enabled inexperienced, firsttime users to perform the assay.
This study sought to provide data on the profile of hiv 1 drug. Hiv drug resistance hivdr testing can assist clinicians in selecting treatments. Hiv drug resistance hivdr is caused by a change mutation in the genetic structure of hiv that affects the ability of a particular. He stressed the importance of hivdr surveillance for measuring the transmitted resistant strains and the. Hiv drug resistance surveillance in subsaharan africa kim sigaloff, md phd. As hiv drug resistance surveillance programs are underway in many countries and regions, it has become essential to develop a standard list of mutations to characterize the epidemiology of transmitted drug resistance 1,2,3,4,5. Operational definitions used in this report are presented below. Hiv drug resistance following a decade of the free antiretroviral. Hiv1 drug resistance in treatmentnaive, chronically. The calculation of the sample size of 100 participants was powered. The prevalence is expressed as a percentage of the population at a point in time. A softwareguided hiv1 drug resistance test for low. Throughout this example we will apply the knockoff filter in the fixedx scenario.
Hiv incidence surveillance in florida prevalence vs. As hiv drug resistance surveillance programs are underway in many countries and regions, it has become essential to develop a standard list of mutations to characterize the epidemiology of transmitted drug resistance. The whohivresnet global hiv drug resistance hivdr prevention, surveillance and monitoring strategy was developed by the world health organization who beginning in 2000. Together with harvard, jli is developing a more affordable pooled algorithm of testing for this resistance. The prevalence of tdr varies with geographical location in the united states us, with some national estimates of around 14% in the last two decades 2, 3. Hiv 1 drug resistance in treatmentnaive, chronically. Effective hivdr monitoring and surveillance programs are essential for.
In coordination with the plans for universal access to antiretroviral therapy art, the. Background the estimation and projection conducted in 20 estimated that nepal has approximately 40,723 persons living with hiv plhiv and prevalence of hiv was 0. Public healthoriented approaches to global antiretroviral therapy art delivery have achieved striking reductions in human immunodeficiency virus hiv aids mortality, morbidity, and transmissions during the last decade 1, 2. European surveillance of hiv drug resistance to nrti.
A significant proportion of low abundance transmitted drug resistance to nrti 14. Ecdc seeks to design and implement a pilot reporting system for surveillance of hiv drug resistance hivdr in the european unioneuropean economic area eueea countries. Sequences were aligned and compared with an hiv blymphoadenopathyassociated virus type 1 consensus sequence using visible genetics gene librarian software. Drug susceptibility data comprising 25,434 pi, 19,858 nrti, 11,548 nnrti and 4,606 ini susceptibility results from hiv 1 virus isolates. Surveillance of hiv drug resistance in children receiving. Who the global hiv drug resistance surveillance network. Hiv drug resistance surveillance in honduras after a. Beginning in 2004 as varhs variant, atypical and resistance hiv surveillance and continuing until mid2010.
We appreciate the great support and specimen contribution to the canadian hiv strain and drug resistance surveillance program and the ongoing external quality. Surveillance mutations hiv drug resistance database. Hiv drug resistance surveillance in subsaharan africa. The ability of hiv to mutate and reproduce itself in the presence of antiretroviral drugs is called hiv drug resistance hivdr. Amsterdam institute for global health and development. Surveillance of transmitted hiv drug resistance among. Clinical outcome data comprising genotype, treatments, plasma hiv 1 rna levels and cd4 counts from 14 clinical trials and 1500 treatmentchange episodes. National strategy on hiv drug resistance monitoring and. Monitoring hivdr patterns is of particular importance in populations such as sex workers sws, where documented hiv prevalence is between 3489%, and in countries with limited therapeutic options.
The essential package of the whohivresnet global hivdr program includes six elements, which are. Summary tables listing the prevalence of each mutation according to subtype and drugclass experience. Limited hiv 1 drug resistance surveillance has been carried out in ghana since the implementation of antiretroviral therapy art. Drug resistance mutations for surveillance of transmitted. National hiv behavioral surveillance nhbs surveillance.
One of the priorities identified in ecdcs molecular surveillance roadmap is to focus on the molecular characterisation of hiv, starting with hivdr. Analysis of hiv drug resistance data stanford university. Genotypic drug resistance testing is widely used for clinical and surveillance. The tdr survey may be embedded within hiv serosurveys to minimize costs and human resources.
Surveillance of hiv drug resistance in adults receiving art acquired hiv drug resistance. Developing a reporting system for the surveillance of hiv. A miseqhydra platform for enhanced hiv drug resistance. Pdf affordable hiv drugresistance testing for monitoring of. Human immunodeficiency virus hiv transmitted drug resistance tdr occurs from the transmission of drug resistant hiv from one individual to another. Our findings warrant the need for enhanced hiv1 tdr monitoring in order. Background a steady increase in hiv drug resistance hivdr has been demonstrated globally in individuals initiating firstline antiretroviral therapy art.
Hiv1 reverse transcriptase and protease mutations for. Surveillance of hiv and tuberculosis drug resistance. Cpr is a tool for routine analysis of hiv1 protease andor rt sequences. The brazilian ministry of health has been sponsoring a policy of universal access to antiretroviral drugs for aids patients since 1996. Surveillance of hiv drug resistance in children receiving antiretroviral. Surveillance drug resistance mutation sdrm worksheet. National strategy on hiv drug resistance monitoring and surveillance hivdr for nepal 2014 2020 1 1. The stanford hiv drug resistance database hivdb provides an online genotypic resistance interpretation program to help clinicians and laboratories interpret hiv1 genotypic resistance tests. Human immunodeficiency virus hiv transmitted drug resistance tdr occurs from the transmission of drugresistant hiv from one individual to another.
Through hiv surveillance, dhap monitors many facets of the trends in hiv infection in the united states. Hiv1 pol sequences were scored for drug resistance mutations using. Conventional hiv drug resistance hivdr genotyping utilizes. The program accepts rt, protease andor integrase sequences submitted by the user and returns a list of penalty scores for each drm and an estimate of reduced susceptibility for. The global hiv drug resistance surveillance network will track the drug susceptibility of hiv in a rapidly moving epidemic, to provide information necessary to develop effective treatment strategies.
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