Novel Strategy for HIV Drug Resistance Monitoring in Developing Countries.

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DESCRIPTION (provided by applicant): The increase in antiretroviral use globally to treat HIV infections has been a much needed and worthy achievement as many thousands of lives have been saved by the rapid expansion of treatment. A natural byproduct of the increased use of these medications is the acquisition of drug resistance in patients failing therapy that will ultimately result in transmitted drug resistance. The timing of the increase in transmitted resistance, so that it impacts national antiretroviral therapy (ART) programs, is unclear, but in resource-limited regions, where it is not feasible to test all individuals for drug resistance at the time they enter care, alternative strategies to monitor resistance are needed. We hypothesize that transmitted drug resistance can be monitored with novel strategies in Botswana. In Specific Aim 1, we propose to conduct surveillance for transmitted HIV drug resistance in Botswana for four consecutive years using a surveillance method developed by the World Health Organization (WHO) in addition to our novel strategy of pooling samples and applying highly sensitive assays to detect drug resistance mutations critical to 1st line ART. This strategy will be validated by the standard genotyping results obtained by the WHO protocol. In Specific Aim 2, we restrict this method of pooling samples to only those individuals with recent HIV infection to see if this improves our ability to monitor transmitted drug resistance and also will closely evaluate transmission pairs to learn about the dynamics of transmission between partners. In Specific Aim 3, we will compare a pooling strategy to detect HIV drug resistance with a standard in-house genotyping technique to determine if this approach to genotyping provides meaningful, cost-effective, results prior to ART initiation. The data generated by this technique would again focus on those mutations relevant to 1st line ART to aid clinicians in predicting success of this therapy. The studies to be performed in this research will characterize the current state of transmitted drug resistance in Botswana by conventional and novel techniques and determine the feasibility of new strategies to monitor for the emergence of HIV drug resistance in resource-limited regions; essential components of monitoring to ensure the continued success of the ART program in Botswana.