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Projected Uptake of New Antiretroviral (ARV) Medicines in Adults in Low- and Middle-Income Countries: A Forecast Analysis 2015-2025.
PloS One. 2016; 11(10):e0164619.With anti-retroviral treatment (ART) scale-up set to continue over the next few years it is of key importance that manufacturers and planners in low- and middle-income countries (LMICs) hardest hit by the HIV/AIDS pandemic are able to anticipate and respond to future changes to treatment regimens, generics pipeline and demand, in order to secure continued access to all ARV medicines required. We did a forecast analysis, using secondary WHO and UNAIDS data sources, to estimate the number of people living with HIV (PLHIV) and the market share and demand for a range of new and existing ARV drugs in LMICs up to 2025. UNAIDS estimates 24.7 million person-years of ART in 2020 and 28.5 million person-years of ART in 2025 (24.3 million on first-line treatment, 3.5 million on second-line treatment, and 0.6 million on third-line treatment). Our analysis showed that TAF and DTG will be major players in the ART regimen by 2025, with 8 million and 15 million patients using these ARVs respectively. However, as safety and efficacy of dolutegravir (DTG) and tenofovir alafenamide (TAF) during pregnancy and among TB/HIV co-infected patients using rifampicin is still under debate, and ART scale-up is predicted to increase considerably, there also remains a clear need for continuous supplies of existing ARVs including TDF and EFV, which 16 million and 10 million patients-respectively-are predicted to be using in 2025. It will be important to ensure that the existing capacities of generics manufacturers, which are geared towards ARVs of higher doses (such as TDF 300mg and EFV 600mg), will not be adversely impacted due to the introduction of lower dose ARVs such as TAF 25mg and DTG 50mg. With increased access to viral load testing, more patients would be using protease inhibitors containing regimens in second-line, with 1 million patients on LPV/r and 2.3 million on ATV/r by 2025. However, it will remain important to continue monitoring the evolution of ARV market in LMICs to guarantee the availability of these medicines.
Bulletin of the World Health Organization. 2016; 94:782-784.In conclusion, WHO clinical guidelines have become increasingly evidence-based through the use of rigorous methods of synthesizing the evidence. Over the past decade, high-quality, pairwise meta-analyses have been widely used in this context, but network meta-analysis methods are increasingly important for the optimal evaluation of competing interventions. We expect that network meta-analysis will increasingly be used and adapted for developing other guidelines. (Excerpt)
MMWR. Morbidity and Mortality Weekly Report. 2016 Feb 12; 65(5):115-9.Blood transfusion is a life-saving medical intervention; however, challenges to the recruitment of voluntary, unpaid or otherwise nonremunerated whole blood donors and insufficient funding of national blood services and programs have created obstacles to collecting adequate supplies of safe blood in developing countries (1). Since 2004, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has provided approximately $437 million in bilateral financial support to strengthen national blood transfusion services in 14 countries in sub-Saharan Africa and the Caribbean* that have high prevalence rates of human immunodeficiency virus (HIV) infections. CDC analyzed routinely collected surveillance data on annual blood collections and HIV prevalence among donated blood units for 2011-2014. This report updates previous CDC reports (2,3) on progress made by these 14 PEPFAR-supported countries in blood safety, summarizes challenges facing countries as they strive to meet World Health Organization (WHO) targets, and documents progress toward achieving the WHO target of 100% voluntary, nonremunerated blood donors by 2020 (4). During 2011-2014, overall blood collections among the 14 countries increased by 19%; countries with 100% voluntary, nonremunerated blood donations remained stable at eight, and, despite high national HIV prevalence rates, 12 of 14 countries reported an overall decrease in donated blood units that tested positive for HIV. Achieving safe and adequate national blood supplies remains a public health priority for WHO and countries worldwide. Continued success in improving blood safety and achieving WHO targets for blood quality and adequacy will depend on national government commitments to national blood transfusion services or blood programs through increased public financing and diversified funding mechanisms for transfusion-related activities.
Adoption of national recommendations related to use of antiretroviral therapy before and shortly following the launch of the 2013 WHO consolidated guidelines.
AIDS. 2014 Mar; 28 Suppl 2:S217-24.OBJECTIVE: To determine the status of key national policies on the use of antiretroviral therapy (ART) at the time of the launch of the 2013 WHO consolidated guidelines as well as to track early progress towards adoption of these recommendations following dissemination. DESIGN: Descriptive analysis of global data on baseline ART policies as of June 2013 and early intentions to adopt the 2013 WHO for use of antiretroviral drugs guidelines as of November 2013. METHODS: Compilation of existing global reports on key HIV policies, review of national guidelines, data collection through annual drug procurement surveys and through guidelines dissemination meetings in each of the six WHO regions. RESULTS: Data were available from 124 low- and middle-income countries, including 97% of the 57 high-priority countries that have been identified by WHO and the Joint United Nations Program on HIV/AIDS (UNAIDS). At baseline, only one country reported recommending antiretroviral therapy (ART) at a CD4 T-cell count 250 cells/mul or less for adults and adolescents in 2013, whereas nine countries already recommended using CD4 T-cell count 500 cells/mul or less. Recommendations for ART initiation regardless of CD4 T-cell count for HIV-infected patients with tuberculosis (86%), hepatitis B (75%), all HIV-infected women who were pregnant or breastfeeding (option B+: 40%) or HIV-infected persons in a serodiscordant relationship (26%) had been nationally adopted as of June 2013. Eight of 67 countries (12%) already recommended treating all children less than 5 years of age. The triple antiretroviral combination of tenofovir + lamivudine (or emtricitabine) + efavirenz was recommended as the preferred first-line option for adults and adolescents more frequently (51%) than for pregnant women (38%), or for both adults/adolescents and pregnant women (28%; P < 0.05). Fewer than half (37%) of all countries reported recommending lopinavir/ritonavir for all HIV-infected children less than 3 years of age; 54% of countries reported recommending routine viral load monitoring, whereas only 41% recommended nurse-initiated ART. CONCLUSIONS: A number of key WHO policy recommendations on antiretroviral drug use were adopted rapidly by countries in advance of or shortly following the launch of the 2013 guidelines. Efforts are needed to support and track ongoing policy adoption and ensure that it is accompanied by the scale-up of evidence-based interventions.
Best Practice and Research. Clinical Obstetrics & Gynaecology. 2014 Aug; 28(6):917-30.Many women in the reproductive years have chronic medical conditions that are affected by pregnancy or in which the fetus is placed at increased risk. In most of these women, ongoing medical management of their conditions is greatly improved, even compared with a decade or two ago. However, their condition may still be seriously exacerbated by the physiological changes of pregnancy, and close monitoring of a carefully planned pregnancy is optimal. This requires effective and safe contraceptive use until pregnancy is desired and the medical condition is stabilised. Many contraceptives will also have adverse effects on some medical conditions, and there is now a considerable awareness of the complexities of some of these interactions. For this reason the World Health Organization has developed an excellent, simple and pragmatic programme of guidelines on a four point scale (the WHO "Medical Eligibility Criteria": WHO-MEC), summarising risk of specific contraceptive methods in women with specified chronic medical conditions. The general approach to contraceptive management of many of these conditions is addressed in this article. Copyright (c) 2014. Published by Elsevier Ltd.
Geneva, Switzerland, UNAIDS, 2011 Oct.  p.These guidelines to UNAIDS’ preferred terminology have been developed for use by staff members, colleagues in the Programme’s 10 Cosponsoring organisations, and other partners working in the global response to HIV. Language shapes beliefs and may influence behaviours. Considered use of appropriate language has the power to strengthen the global response to the epidemic. UNAIDS is pleased to make these guidelines to preferred terminology freely available. It is a living, evolving document that is reviewed on a regular basis. Comments and suggestions for additions, deletions, or modifications should be sent to firstname.lastname@example.org.
Clinics In Perinatology. 2010 Dec; 37(4):765-76, viii.The World Health Organization's Strategic Approaches to the Prevention of HIV Infection in Infants includes 4 components: primary prevention of HIV-1 infection; prevention of unintended pregnancies among HIV-1-infected women; prevention of transmission of HIV-1 infection from mothers to children; and provision of ongoing support, care, and treatment to HIV-1-infected women and their families. This review focuses on antiretrovirals for secondary prevention of HIV-1 infection-prevention of HIV-1 transmission from an HIV-1-infected woman to her child. Antiretroviral strategies to prevent the mother-to-child transmission of HIV-1 in nonbreastfeeding populations comprise antiretroviral treatment of HIV-1-infected pregnant women needing antiretrovirals for their own health, antiretroviral prophylaxis for HIV-1-infected pregnant women not yet meeting criteria for treatment, and antiretroviral prophylaxis for infants of HIV-1-infected mothers. The review primarily addresses antiretroviral strategies for nonbreastfeeding, HIV-1-infected women and their infants in resource-rich settings, such as the United States. Antiretroviral strategies to prevent antepartum, intrapartum, and early postnatal transmission in resource-poor settings are also addressed, albeit more briefly. Copyright (c) 2010 Elsevier Inc. All rights reserved.
Lancet. 2010 Dec 4; 376(9756):1874.This editorial argues that despite the report by UNAIDS that the trajectory of the HIV epidemic has been broken, a US Institute of Medicine (IOM) report paints a bleaker picture for the immediate future of HIV/AIDS in Africa. The IOM report states that sub-Saharan Africa bears 68% of the worldwide burden of HIV infection and the gap is growing between the number of people needing treatment and the availability of resources.
New York, New York, United Nations, Department of Economic and Social Affairs, 2007 Jun. 36 p.Since their adoption by all United Nations Member States in 2000, the Millennium Declaration and the Millennium Development Goals have become a universal framework for development and a means for developing countries and their development partners to work together in pursuit of a shared future for all. The Millennium Declaration set 2015 as the target date for achieving most of the Goals. As we approach the midway point of this 15-year period, data are now becoming available that provide an indication of progress during the first third of this 15-year period. This report presents the most comprehensive global assessment of progress to date, based on a set of data prepared by a large number of international organizations within and outside the United Nations system. The results are, predictably, uneven. The years since 2000, when world leaders endorsed the Millennium Declaration, have seen some visible and widespread gains. Encouragingly, the report suggests that some progress is being made even inthose regions where the challenges are greatest. These accomplishments testify to the unprecedented degree of commitment by developing countries and their development partners to the Millennium Declaration and to some success in building the global partnership embodied in the Declaration. The results achieved in the more successful cases demonstrate that success is possible in most countries, but that the MDGs will be attained only if concerted additional action is taken immediately and sustained until 2015. All stakeholders need to fulfil, in their entirety, the commitments they made in the Millennium Declaration and subsequent pronouncements. (excerpt)
New York, New York, United Nations, Department of Economic and Social Affairs, Population Division, 2008 Mar.  p. (ST/ESA/SER.A/270)The AIDS epidemic remains one of the greatest challenges confronting the international community. In countries with a large number of people living with HIV, all population and development indicators are affected by the epidemic. Governments often cite HIV/AIDS as their most significant demographic concern. For more than two decades, the rapidly expanding HIV/AIDS epidemic has triggered a wide array of responses at the national, regional and global levels. The goals established by the United Nations General Assembly in the 2000 Millennium Declaration and through the adoption of the 2001 Declaration of Commitment on HIV/AIDS reflect widely-held concerns about the impact of the epidemic on development and human well-being. More recently, at the 2006 High Level Meeting on AIDS, Member States adopted a Political Declaration focusing on how to attain universal access to comprehensive HIV/AIDS prevention programs, treatment, care and support by 2010. (excerpt)
New York, New York, UNICEF, 2008 Apr. 48 p.This report will focus on three major themes. First, strengthening communities and families is crucial to every aspect of a child-centred approach to AIDS. Support by governments, NGOs and other actors should therefore be complementary to and supportive of these family and community efforts, through, for example, ensuring access to basic services. Second, interventions to support children affected by HIV and AIDS are most effective when they form part of strong health, education and social welfare systems. Unfortunately, because maternal and child health programmes are weak in many countries, millions of children, HIV-positive and -negative alike, go without immunization, mosquito nets and other interventions that contribute to the overall goal of HIV-free child survival. A final theme of this report is the challenge of measurement. Documenting advances and shortfalls strengthens commitment and guides progress. A number of countries have data available on the 'Four Ps', and targeted studies are being developed to assess the situation of the marginalized young people who are most at risk but often missed in routine surveys. (excerpt)
International guidelines on HIV / AIDS and human rights. 2006 consolidated version. Second International Consultation on HIV / AIDS and Human Rights, Geneva, 23-25 September 1996. Third International Consultation on HIV / AIDS and Human Rights, Geneva, 25-26 July 2002. Organized jointly by the Office of the United Nations High Commissioner for Human Rights and the Joint United Nations Programme on HIV / AIDS.
Geneva, Switzerland, Office of the United Nations High Commissioner for Human Rights, 2006. 115 p. (HR/PUB/06/9)The International Guidelines on HIV/AIDS and Human Rights arose because of various calls for their development in light of the need for guidance for Governments and others on how to best promote, protect and fulfill human rights in the context of the HIV epidemic. During the first International Consultation on AIDS and Human Rights, organized by the United Nations Centre for Human Rights, in cooperation with the World Health Organization, in Geneva, from 26 to 28 July 1989, participants discussed the possible elaboration of guidelines to assist policymakers and others in complying with international human rights standards regarding law, administrative practice and policy. Several years later, in his report to the Commission at its fifty-first session (E/CN.4/1995/45, para.135), the United Nations Secretary-General stated that "the development of such guidelines or principles could provide an international framework for discussion of human rights considerations at the national, regional and international levels in order to arrive at a more comprehensive understanding of the complex relationship between the public health rationale and the human rights rationale of HIV/AIDS. In particular, Governments could benefit from guidelines that outline clearly how human rights standards apply in the area of HIV/AIDS and indicate concrete and specific measures, both in terms of legislation and practice, that should be undertaken". (excerpt)
Geneva, Switzerland, UNAIDS, 2007 Dec. 50 p. (UNAIDS/07.27E; JC1322E)Every day, over 6800 persons become infected with HIV and over 5700 persons die from AIDS, mostly because of inadequate access to HIV prevention and treatment services. The HIV pandemic remains the most serious of infectious disease challenges to public health. Nonetheless, the current epidemiologic assessment has encouraging elements since it suggests: the global prevalence of HIV infection (percentage of persons infected with HIV) is remaining at the same level, although the global number of persons living with HIV is increasing because of ongoing accumulation of new infections with longer survival times, measured over a continuously growing general population; there are localized reductions in prevalence in specific countries; a reduction in HIV-associated deaths, partly attributable to the recent scaling up of treatment access; and a reduction in the number of annual new HIV infections globally. Examination of global and regional trends suggests the pandemic has formed two broad patterns: generalized epidemics sustained in the general populations of many sub-Saharan African countries, especially in the southern part of the continent; and epidemics in the rest of the world that are primarily concentrated among populations most at risk, such as men who have sex with men, injecting drug users, sex workers and their sexual partners. (excerpt)
Global progress in PMTCT and paediatric HIV care and treatment in low- and middle-income countries in 2004 -- 2005.
Reproductive Health Matters. 2007 Sep; 15(30):179-189.A growing number of countries are moving to scale up interventions for prevention of mother-to-child transmission (PMTCT) of HIV in maternal and child health services. Similarly, many are working to improve access to paediatric HIV treatment. This paper reviews national programme data for 2004-2005 from low- and middle-income countries to track progress in these programmes. The attainment of the UNGASS target of reducing HIV infections by 50% by 2010 necessitates that 80% of all pregnant women accessing antenatal care receive PMTCT services. In 2005, only seven of the 71 countries were on track to meet this target. However PMTCT coverage increased from 7% in 2004 (58 countries) to 11% in 2005 (71 countries). In 2005, 8% of all infants born to HIV positive mothers received antiretroviral prophylaxis for PMTCT, up from 5% in 2004, though only 4% received cotrimoxazole. 11% of HIV positive children in need received antiretroviral treatment in 2005. In 31 countries that had data, 28% of women who received an antiretroviral for PMTCT also reported receiving antiretroviral treatment for their own health. Achieving the UNGASS target is possible but will require substantial investments and commitment to strengthen maternal and child health services, the health workforce and health systems to move from pilot projects to a decentralised, integrated approach. (author's)
Zhonghua Liu Xing Bing Xue Za Zhi / Chinese Journal of Epidemiology. 1997 Oct; 18(5):309-311.Global HIV infection and AIDS: according to WHO estimates, by mid 1996 there were 7 million cumulative AIDS cases. Today the number of people infected with HIV is even more alarming: roughly 21.8 million, of those 42% are women. By the year 2000 there will be between 40 and 50 million cases. Each day about 8,500 additional people are infected with AIDS; one can say the situation is grim. Currently, the AIDS and HIV epidemic regions are shifting, they have gradually moved from the original sites of North America and West Europe toward the mass populations of developing countries in Asia, Africa, and Latin America. In the Asian region which contains about 60% of the world's population, beginning in 1988, with Thailand and India at the center, an exploding epidemic has taken shape. Recent materials indicate, those infected with HIV in Thailand exceed 700,000, over 2 million in India, and the HIV epidemic has already spread to the near neighbors Burma, southern China, Cambodia, Malaysia and Vietnam. With the accumulation of molecular epidemiology research materials, the complete picture of the causes and characteristics of this massive epidemic happening in the Asian region is gradually becoming clear. (excerpt)
Africa Recovery. 1999 Dec; 13(4): p..Within a generation, the world could -- and should -- become a place where every infant is properly nurtured and cared for, where every child receives a quality basic education, and where every adolescent is given the support and guidance he or she needs in the difficult transition to adulthood, says the State of the World's Children 2000, published in December by the UN Children's Fund (UNICEF). Acknowledging the progress made in protecting children over the course of this century and in the decade since the 1989 adoption of the Convention on the Rights of the Child, UNICEF says much more remains to be done. It draws particular attention to three tragedies of which children and women are currently the main victims, largely in the developing world: armed conflict, HIV/AIDS and poverty. And the report adds that women are victims of these ills in disproportionate numbers due to gender discrimination. (excerpt)
New York, New York, UNFPA, 2001. 32 p. (Preventing HIV / Promoting Reproductive Health)UNFPA has worked in the field of population and development for more than three decades and has addressed the issue of HIV/AIDS for the last decade. However, no organization by itself has the capacity or the resources needed to address and halt the pandemic. An effective response requires careful collaboration and coordination among organizations, with each bringing to the partnership a distinct set of capabilities, strengths and comparative advantages. As one of the eight cosponsors of UNAIDS (the other cosponsors being UNICEF, UNDP, UNDCP, UNESCO, ILO, WHO and World Bank), UNFPA chairs Theme Groups in many countries and supports HIV-prevention interventions in almost all of its country programmes. To maximize its response and to strengthen coordinated activities with other partners, it is critical for staff at every level to have a common understanding of the Fund’s policies and strategic priorities. The aim of this document is to provide such guidance to staff, delineating the niche in which UNFPA as an organization has a definite comparative advantage in addressing the HIV/AIDS epidemic, especially at the country level. (excerpt)
Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: guidelines on care, treatment and support for women living with HIV / AIDS and their children in resource-constrained settings.
Geneva, Switzerland, WHO, 2004. v, 49 p.Mother-to-child transmission (MTCT) is the most important source of HIV infection in children. In 2001, the United Nations General Assembly Special Session on HIV/AIDS committed countries to reduce the proportion of infants infected with HIV by 20% by 2005 and by 50% by 2010. Achieving this urgently requires an increase in access to integrated and comprehensive programmes to prevent HIV infection in infants and young children. Such programmes consist of interventions focusing on primary prevention of HIV infection among women and their partners; prevention of unintended pregnancies among HIV-infected women; prevention of HIV transmission from HIV-infected women to their children; and the provision of treatment, care and support for women living with HIV/AIDS, their children and families. WHO convened a Technical Consultation on Antiretroviral Drugs and the Prevention of Mother-to-child Transmission of HIV Infection in Resource-limited Settings in Geneva, Switzerland on 5–6 February 2004. Scientists, policymakers, programme managers and community representatives reviewed the most recent experience with programmes and evidence on the safety and efficacy of various antiretroviral (ARV) regimens for preventing HIV infection in infants. This information was reviewed in the context of the rapid expansion of ARV treatment in resource-constrained settings using standardized and simplified drug regimens. Prior to the Technical Consultation, a draft set of recommendations had been issued for public comment. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], HIV / AIDS Branch, UNAIDS Inter-Agency Task Team on Young People, 2004. 8 p.Young people remain at the centre of the epidemic in terms of transmission, vulnerability, impact, and potential for change. Today’s young generation, the largest in history, has not known a world without AIDS. Of the over 1 billion young people worldwide, 10 million are currently living with HIV. If we are to reach the global targets set forth in international agreements, urgent action and increased investment must be made in HIV prevention, treatment and care programmes specifically for young people. (excerpt)
Sport for development and peace: towards achieving the Millennium Development Goals. Report from the United Nations Inter-Agency Task Force on Sport for Development and Peace.
New York, New York, United Nations, 2003. vi, 36 p.This report analyses in detail the potential contribution that sport can make towards achieving the United Nations Millennium Development Goals (MDGs). It provides an overview of the growing role that sports activities are playing in many United Nations programmes and crystallizes the lessons learned. It also includes recommendations aimed at maximizing and mainstreaming the use of sport. (excerpt)
Technical advisory meeting on implications of the newly identified HIV-1 subtype O viruses for HIV diagnosis. Press release.
Geneva, Switzerland, WHO, 1994 Jun 24. 2 p. (Press Release WHO/50)HIV is characterized by an high level of genetic diversity. HIV types HIV-1 and HIV-2 have been identified, and HIV-1 variants have been grouped by their gag and env sequences into at least eight subtypes, subtypes A-H. Divergent HIV-1 subtypes also have recently been identified which cannot be classified in any of the existing HIV-1 subtypes and are thus designated as subtype O for "genetic outliers". Limited available sequence data from HIV-1 subtype O viruses suggest that diversity within the subtype O group may be as great as that which exists between HIV-1 subtypes A-H. The majority of virus strains classified as HIV-1 subtype O have been isolated from patients of Cameroonian origin or their sexual contacts although recent preliminary studies in Cameroon suggest that less than 10% of HIV-1 infections there are caused by subtype O strains. A few subtype O infections have also been reported in Gabon and France, but limited studies have found no evidence of the presence of HIV-1 subtype O in Belgium, Cote d'Ivoire, Kenya, Togo, and Zaire. The ability of currently available anti-HIV assays to identify individuals infected with subtype O has not been extensively studied. An informal consultation of 22 international experts on the implications of this newly identified subtype for HIV diagnosis took place June 9-10, 1994, at World Health Organization headquarters. In general, one is more likely to fail in detecting HIV infection because of the absence of antibody in the seroconversion window phase than from infection with an highly divergent HIV subtype. The existence of these subtype O viruses is therefore likely to have little, if any, impact upon HIV diagnosis and blood safety outside of the area where they are prevalent. The expert group recommended that diagnostic tests and strategies for HIV antibody testing be urgently reevaluated in the region where subtype O virus has been found, a panel of sera be collected from asymptomatic and symptomatic individuals to use in assessing the sensitivity of available HIV antibody assays for antibodies against HIV-1 subtype O, envelope genes of subtype O isolates be sequenced to provide information useful in the production of HIV antibody assays and the determination of the relatedness of HIV strains, expanding the global surveillance of newly recognized HIV subtypes, and developing and evaluating algorithms for the detection and further characterization of variant HIV strains.
Journal of Acquired Immune Deficiency Syndromes. 2002 Feb 1; 29(2):184-90.The objective of this study was to estimate the global distribution and regional spread of different HIV-1 genetic subtypes and circulating recombinant forms (CRFs) in the year 2000. These estimates were made based on data derived from global HIV/AIDS surveillance and molecular virology studies. HIV-1 incidence during the year 2000 was estimated in defined geographic regions, using a country-specific model developed by WHO-Joint UN Programmes on HIV/AIDS (UNAIDS). The proportion of new infections caused by different HIV-1 subtypes in the same geographic regions was estimated by experts from the WHO-UNAIDS Network for HIV Isolation and Characterization, based on results generated by HIV molecular epidemiology studies in 1998-2000. The absolute numbers and relative proportions of new infections due to different genetic subtypes of HIV- 1 by different geographic regions were calculated using these two sets of estimated data. The results of the study demonstrated that the epidemiology of HIV-1 subtypes and CRFs is characterized by their differential distribution and varying significance as a driving cause of the pandemic on regional and global basis. The largest proportion of HIV-1 infections in the year 2000 was due to subtype C strains (47.2%). Subtype A/+CRF02_AG was estimated to be the second leading cause of the pandemic (27%), followed by subtype B strains (12.3%). The same analysis confirmed an increasing role of HIV-1 CRFs in the pandemic. The authors conclude that combined analysis of data based on the global HIV/AIDS surveillance and molecular virology studies provides for a useful model to monitor the dynamics of the global spread of HIV-1 subtypes and CRFs on regional and country levels--the information of potential importance for diagnosis and treatment of HIV/AIDS, as well as for the development globally effective HIV vaccines. (author's)
In: International Symposium on Biomedical Research Issues of HIV Infection in Thailand. Bangkok, Thailand, January 31 - February 2, 1994. Sponsors: Thailand Health Research Institute, Harvard AIDS Institute, Ministry of Public Health of Thailand, Center for Vaccine Development, Mahidol University. Cambridge, Massachusetts, Harvard AIDS Institute, 1994. 4-6.HIV-1 is a complex retrovirus characterized by extensive genetic variation due to numerous errors in reverse transcription and involving different geneses of the mutations. At least six nearly equidistant genetic clades, or subtypes, can be identified based upon the phylogenetic analysis of the env coding sequences. HIV-1 variability may make it difficult to develop vaccines which are effective against the various HIV-1 strains prevalent in different geographic locations. With the goal of establishing a mechanism for monitoring HIV-1 variability on a global basis, the Global Program on AIDS of the World Health Organization (WHO) established the WHO Network for HIV-1 Isolation and Characterization. The network constitutes an integral part of the WHO Strategy for HIV-1 Vaccine Development. It is formed by primary laboratories in Brazil, Rwanda, Thailand, and Uganda, the WHO-sponsored sites for the development and field evaluation of HIV-1 vaccines; 15 secondary/expert laboratories in France, Germany, Spain, Sweden, the Netherlands, the UK, and the US which conduct detailed characterization of HIV-1 strains; centralized facilities in Germany and the UK for the isolation of HIV-1 strains following standard procedures; repositories for the storage and distribution of viral isolates and other reagents in the UK and the US; and data management facilities in collaboration with the Los Alamos HIV-1 Database in the US. Five of the six known HIV-1 genetic subtypes were found through genetic screening of HIV-1 strains collected from the four sites. In most cases, more than one subtype was present in the same country. Biologic characterization of the HIV-1 isolates determined that most of the viral strains collected in Brazil, Rwanda, and Thailand can be defined as slow/low phenotypes and were non-syncytia inducing. The Ugandan isolates belonging to subtype D, but not to subtype A, were characterized by the highest replicative capacities and were syncytia-inducing viruses. There is as yet no explanation for this latter finding.