Assessing HIV resistance in developing countries: Brazil as a case study El cálculo de la resistencia medicamentosa del VIH en países en desarrollo: el caso del Brasil

• Main Authors: Maya L. Petersen, Marie-Claude Boily, Francisco I. Bastos
• Format: Article in Journal/Newspaper
• Language: English; Spanish; Portuguese
• Published: Pan American Health Organization 2006
• Subjects: VIH; agentes anti VIH; terapia antirretroviral altamente activa; resistencia viral a drogas; países en desarrollo; Brasil; HIV; anti-HIV agents; antiretroviral therapy; drug resistance; viral; developing countries; Brazil; Medicine; R; Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doaj.org/article/bd0b71961dfd4b9a8e223772a0d8fab5

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. 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 ...