HIV Drug Resistance Prevention and Assessment
Description
Since its introduction, antiretroviral (ARV) drug therapy has dramatically reduced morbidity and mortality associated with HIV infection. The use of combination drug therapies can significantly improve HIV patients’ chances for long-term survival. Unfortunately, the effectiveness of ARV therapy can be markedly reduced by the emergence of drug resistance. Successful treatment of HIV requires a detailed knowledge of the various mechanisms by which resistance can arise as well as an understanding of strategies for overcoming resistance once it occurs.
The aim of this course is to increase understanding of the determinants of HIV drug resistance (HIVDR) and the identification of ways to minimize its spread. HIV drug resistance surveillance is a critical adjunct to all country-level ARV programmes, as it helps detect the circulation of resistance strains in the early stages of the implementation of the ARV programmes and to prevent transmission of HIVDR.
Learning objectives
The key objective of the course is to introduce participants to principles and components of national HIV resistance prevetion and assessment. The course addresses HIV drug resistance early warning indicators (EWI) at ART sites, EWI data collection tools, EWI analysis and reporting; Issues in the development of drug resistance during treatment; Resistance testing and interpretation; web-based and freeware tools. Participants will learn how to select representative sentinel sites for monitoring of HIVDR and how to develop protocols for HIVDR surveys which includes development of a budget and timeline.
Key topics
- Introduction to the development of antiretroviral drug resistant strains of HIV during ART, transmission of drug resistant strains of HIV, and the effect of drug resistance on treatment outcomes
- Mutations associated with HIV drug resistance (HIVDR)
- Testing for HIVDR in the laboratory, with a focus on genotyping of the pol gene
- Monitoring ART clinic operations to minimize HIV drug resistance ("HIV drug resistance Early Warning Indicator")
- Epidemiologic and statistical considerations in setting up,
implementing, and analyzing results from a survey or research study - Surveys to evaluate HIV drug resistance prevention in sentinel ART sites
- Surveys to evaluate transmitted HIV drug resistance in specific
geographic areas - Information technology tools and applications for HIV drug
resistance surveys - WHO recommendations for development of a national HIVDR prevention and assessment strategy
- Organization of a national HIVDR working group; developing a national plan
Key references:
Bennett DE, Bertagnolio S, Sutherland D, Gilks CF. The World Health Organization’s global strategy for prevention and assessment of HIV drug resistance. Antiviral Therapy 2008; 13 Suppl 2; 1-13.
Bertagnolio S, et al. World Health Organization/HIVResNet Drug Resistance Laboratory Strategy. Antiviral Therapy; 13 Suppl 2; 49-57.
Shafer RW, Rhee SY, Bennett D. Consensus drug resistance mutations for epidemiologic surveillance: basic principles and potential controversies. Antiviral Therapy; 13 Suppl 2; 59-68.
Jordan MR, Bennett DE, Bertagnolio S, Gilks CF, Sutherland D. World Health Organization surveys to monitor HIV drug resisatnce prevention and associated factors in sentinel antiretroviral treatmenet sites. Antiviral Therapy; 13 Suppl 2; 15-23.
Stanford University HIV Drug Resistance Database
Teaching Methods
Lectures, hands-on workshops, discussions
Target Audience
Focal persons in national AIDS programmes who are responsible for HIV drug resistance prevention and assessment, epidemiologists, public health professionals, virologists.
Duration:
The course takes place in five days.
Partners:
World Health Organization, HQ
University Hospital for Infectious Disease „Dr. Fran Mihaljević“
Faculty:
Dr. David Bangsberg, Harvard Medical School
Dr. Diane Bennett, World Health Organization
Dr. Caroline Smith, University College London
Dr. Steven Hong, Tufts University School of Medicine
Dr. Michael Jordan, New England Medical Centre
Dr. Annamaria Geretti, Royal Free and University Hospital Medical Centre
Professor Caroline Sabin, University College London
Downloads:
Programme: HIV Drug Resistance Prevention and Assessment
