Abstract
BackgroundUniversal 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.Methods and FindingsWe 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.ConclusionsIf 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.
Highlights
HIV/AIDS arose in Asia in the early-to-mid 1980s
If viral load testing of people on antiretroviral therapy (ART) is carried out on a yearly basis and virological failure leads to effective second-line therapy, transmitted drug resistance could be reduced by 80%
Our model describes the unique nature of Asian HIV epidemics whereby epidemics typically emerge and are initially driven by injecting drug use and sex work
Summary
By the 1990s HIV epidemics had established in numerous countries; among the worst affected were Thailand and Cambodia with HIV prevalence levels of 1–2%. Thailand, Cambodia, and Myanmar have been experiencing declines in HIV prevalence [1,2], countries such as Vietnam, Indonesia, Pakistan and China have observed growth in their epidemics [3]. Effective antiretroviral therapy (ART) is currently being scaled up in most countries in the region. With greater treatment coverage there is concern about the development of drug resistance, especially in countries where second-line therapy is not widely available. 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.
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