Monitoring the Emergence of Antiretroviral Resistance

The World Health Organization (WHO) has played a leading role in developing
strategies for the surveillance and containment of antimicrobial resistance in bacterial
and parasitic diseases. The goal has been to optimize patient care and to minimize the
emergence and spread of antimicrobial drug resistance. Just as for bacterial and parasitic diseases, a global resistance monitoring programme is also needed for HIV/AIDS. In the developed world the remarkable reduction of HIVrelated morbidity and mortality produced by potent antiretroviral therapy has been
accompanied by an increase in the prevalence of drug-resistant viruses unresponsive to
available therapies. In the developing world, as access to antiretroviral agents increases,
drug resistance may be enhanced by inappropriate treatment and lack of adherence to
treatment regimens. The need to develop a global antiretroviral resistance monitoring programme was
addressed at the consultation organized by WHO in collaboration with the International
AIDS Society (IAS) and the Istituto Superiore di Sanità (ISS) and held in Rome,
October 2000. It was proposed that WHO, in collaboration with IAS, develop a detailed plan of action
involving partnerships with existing antiretroviral (ARV) resistance monitoring centres
and networks. The plan will be based on the following priorities agreed upon by the
participants at the consultation: 

• to identify sites that are currently involved in HIV-1 drug resistance monitoring
activities and to catalogue these activities
• to develop uniform criteria for the collection and reporting of HIV-1 drug resistance
• to develop and maintain a surveillance system that determines HIV-1 drug resistance
among:
• previously untreated patients
• targeted ARV-experienced populations (e.g. those who have a history of ARV
therapy; those who are receiving active therapy; or those who have received
therapy through perinatal transmission prevention programmes)
• to monitor simultaneously the subtype of circulating HIV-1 strains by using protease
and/or reverse transcripts sequences
• to determine trends in the prevalence of drug resistance in different geographical
areas in relation to the introduction of ARV therapy
• to establish linkages between surveillance sites and quality controlled laboratories
and to promote technology transfer of drug resistance testing methodologies to sites
in the developing world
• to promote education about strategies that reduce the selection of antiretroviral
resistance.
http://apps.who.int/medicinedocs/index/assoc/s16347e/s16347e.pdf