Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/556
Title: Assessing HIV resistance in developing countries: Brazil as a case study
Authors: Petersen, Maya L.
Boily, Marie-Claude
Bastos, Francisco Inácio Pinkusfeld Monteiro
Affilliation: University of California Berkeley. School of Public Health, Division of Epidemiology. Berkeley, California, USA.
Imperial College. Department of Infectious Diseases Epidemiology. London, United Kingdom.
Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Laboratório de Informação em Saúde. Rio de Janeiro, RJ, Brasil.
Abstract: Increased transmission of resistant HIV has been raised as a potential consequence of expanded access to antiretroviral therapy. We review how limitations in resources and health care infrastructure may impact the transmission of resistant HIV, and we examine data from Brazil as a case study. We introduce a biological and clinical framework to identify the major determinants of transmitted resistance and to discuss how these determinants may be affected by a lack of infrastructure. We then use our framework to examine HIV resistance data from Brazil. This country was chosen as a case study due to its extensive experience delivering antiretroviral drugs and because of the availability of data on the prevalence of resistant HIV there. The data from Brazil show that antiretroviral therapy can be delivered in a resource-limited setting without resulting in widespread transmission of resistant virus. While the Brazilian experience does not necessarily generalize to countries with less health care infrastructure, neither theory nor data support a foregone conclusion that resistance will necessarily dominate HIV epidemics in the developing world to a greater extent than it does in the developed world.
Abstract in spanish: Se ha especulado que el aumento de cepas del virus de la inmunodeficiencia humana (VIH) resistentes a medicamentos podría ser el resultado de un mayor acceso al tratamiento con antirretrovíricos. Tomando como ejemplo datos propios del Brasil, en este trabajo examinamos la manera en que la escasez de recursos y las carencias de la infraestructura sanitaria podrían estar influyendo en la transmisión de cepas resistentes de VIH. Empleamos un marco biológico y clínico para identificar los principales factores determinantes del aumento de la resistencia y exploramos la forma en que dichos factores podrían verse afectados por la falta de infraestructura. Posteriormente empleamos ese mismo marco para examinar las cifras de resistencia del Brasil, país que se eligió como ejemplo porque en él los medicamentos antirretrovíricos han tenido amplia distribución y porque hay abundantes datos acerca de la prevalencia de cepas de VIH en el territorio nacional. Las cifras del Brasil demuestran que se puede administrar el tratamiento con antirretrovíricos en lugares donde hay pocos recursos sin que ello provoque la transmisión generalizada de cepas víricas resistentes. Aunque la experiencia brasileña no necesariamente se puede proyectar a países con menos infraestructura sanitaria, no hay ningún esquema teórico ni datos que respalden la conclusión a priori de que en el mundo en desarrollo la epidemia de VIH transcurrirá con mayores cifras de resistencia que en países desarrollados.
Keywords: HIV
Anti-HIV agents
Antiretroviral therapy
Highly active
Drug resistance
Developing countries
Brazil
Issue Date: 2006
Publisher: Organización Panamericana de la Salud
Citation: PETERSEN, Maya L.; BOILY, Marie-Claude; BASTOS, Francisco Inácio Pinkusfeld Monteiro. Assessing HIV resistance in developing countries: Brazil as a case study. Rev. Panam. Salud Publica, v. 19, n. 9, p. 146-156, 2006.
Description: Acknowledgments. Maya Petersen is supported by a predoctoral fellowship from the Howard Hughes Medical Institute. Francisco I. Bastos is supported by Oswaldo Cruz Foundation PAPES grant 250.250.122 and a Brazilian Research Council (CNPq) salary grant.
ISSN: 1020-4989
Copyright: open access
Appears in Collections:ICICT - Artigos de Periódicos

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