The evolution and impact of HIV-1 resistance following the public health rollout of antiretroviral therapy in Africa. (360G-Wellcome-081772_Z_06_Z)

There around 40.3 million HIV infected people worldwide with 3.1 million deaths in 2005 (half a million were children). Antiretroviral therapy (ART) has been shown to increase survival, and therefore providing ART has been identified as a global public health priority. HIV treatment in the industrialised world is accompanied by regular virological monitoring to limit the emergence of high level resistance, thus optimising response to subsequent therapies. This monitoring is not feasible in the developing world. Maintaining patients on therapy despite viraemia risks the development of more extensive resistance and may compromise choices for second line therapy. Children experience higher viral loads and slower responses to ART. This greater viral turnover provides the potential to develop resistance more rapidly than in adults. We aim to describe the emergence of resistance in African children and to explore relationships with virological fitness and clinical disease. Then we a im to translate these findings to assess the likely efficacy of WHO second-line therapy at a population level. Given that research into optimal sequential therapies for children in the developing world is limited, there is an urgent need for such real life resistance data to inform the evidence-based approach to public health rollout of ART.