dorsal/arxiv
View SchemaThe WHO surveillance threshold and the emergence of drug-resistant HIV strains in Botswana
| Authors | Raffaele Vardavas, Sally Blower |
|---|---|
| Categories | |
| ArXiv ID | q-bio/0512032 |
| URL | https://arxiv.org/abs/q-bio/0512032 |
Abstract
Background: Approximately 40% of adults in Botswana are HIV-infected. The Botswana antiretroviral program began in 2002 and currently treats 34,000 patients with a goal of treating 85,000 patients (~30% of HIV-infected adults) by 2009. We predict the evolution of drug-resistant strains of HIV that may emerge as a consequence of this treatment program. We discuss the implications of our results for the World Health Organization's (WHO's) proposed surveillance system for detecting drug-resistant strains of HIV in Africa. Methods: We use a mathematical model of the emergence of drug resistance. We incorporate demographic and treatment data to make specific predictions as to when the WHO surveillance threshold is likely to be exceeded. Results: Our results show - even if rates of acquired resistance are high, but the drug-resistant strains that evolve are only half as transmissible as wild-type strains - that transmission of drug-resistant strains will remain low (< 5% by 2009) and are unlikely to exceed the WHO's surveillance threshold. However,our results show that transmission of drug-resistant strains in Botswana could increase to ~15% by 2009 if resistant strains are as transmissible as wild-type strains. Conclusion: The WHO's surveillance system is designed to detect transmitted resistance that exceeds a threshold level of 5%. Whether this system will detect drug-resistant strains in Botswana by 2009 will depend upon the transmissibility of the strains that emerge. Our results imply that it could be many years before the WHO detects transmitted resistance in other sub-Saharan African countries with less ambitious treatment programs than Botswana.
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"abstract": "Background: Approximately 40% of adults in Botswana are HIV-infected. The\nBotswana antiretroviral program began in 2002 and currently treats 34,000\npatients with a goal of treating 85,000 patients (~30% of HIV-infected adults)\nby 2009. We predict the evolution of drug-resistant strains of HIV that may\nemerge as a consequence of this treatment program. We discuss the implications\nof our results for the World Health Organization\u0027s (WHO\u0027s) proposed\nsurveillance system for detecting drug-resistant strains of HIV in Africa.\nMethods: We use a mathematical model of the emergence of drug resistance. We\nincorporate demographic and treatment data to make specific predictions as to\nwhen the WHO surveillance threshold is likely to be exceeded. Results: Our\nresults show - even if rates of acquired resistance are high, but the\ndrug-resistant strains that evolve are only half as transmissible as wild-type\nstrains - that transmission of drug-resistant strains will remain low (\u003c 5% by\n2009) and are unlikely to exceed the WHO\u0027s surveillance threshold. However,our\nresults show that transmission of drug-resistant strains in Botswana could\nincrease to ~15% by 2009 if resistant strains are as transmissible as wild-type\nstrains. Conclusion: The WHO\u0027s surveillance system is designed to detect\ntransmitted resistance that exceeds a threshold level of 5%. Whether this\nsystem will detect drug-resistant strains in Botswana by 2009 will depend upon\nthe transmissibility of the strains that emerge. Our results imply that it\ncould be many years before the WHO detects transmitted resistance in other\nsub-Saharan African countries with less ambitious treatment programs than\nBotswana.",
"arxiv_id": "q-bio/0512032",
"authors": [
"Raffaele Vardavas",
"Sally Blower"
],
"categories": [
"q-bio.PE",
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"title": "The WHO surveillance threshold and the emergence of drug-resistant HIV strains in Botswana",
"url": "https://arxiv.org/abs/q-bio/0512032"
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