Recommendations for surveillance of transmitted HIV drug resistance in countries scaling up antiretroviral treatment

Antivir Ther. 2008;13 Suppl 2:25-36.


Background: The World Health Organization (WHO) HIV drug resistance (HIVDR) threshold survey method was developed for surveillance of transmitted HIVDR in resource-limited countries. The method is being implemented with minimal resources as a routine public health activity to produce comparable results in multiple countries and areas within countries. Transmitted drug resistant HIV strains will be seen first in cities or health districts where antiretroviral treatment (ART) has been widely available for years. WHO recommends countries begin surveillance in these areas.

Methods: Each survey requires < or =47 specimens from individuals consecutively diagnosed with HIV to categorize resistance to each relevant drug class as <5%, 5-15% or >15%. Use of routinely collected information and remnant specimens is recommended to minimize costs. Site and individual eligibility criteria are designed to minimize inclusion of ARV-experienced individuals and individuals infected before ART was available.

Results: Surveys have been implemented in 21 countries. In this supplement, seven countries report results of <5% transmitted HIVDR in areas where ART has been available for the longest time period. The main challenges in implementation are acquiring sufficient numbers of eligible specimens and optimizing specimen handling.

Conclusion: The WHO HIVDR threshold survey method is feasible in resource-limited countries and produces information relevant to ART and drug resistance prevention planning.

MeSH terms

  • Anti-Retroviral Agents / therapeutic use*
  • Developing Countries*
  • Drug Resistance, Viral* / genetics
  • Evidence-Based Medicine
  • Genotype
  • HIV / genetics
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / transmission
  • HIV Infections / virology
  • Health Care Surveys
  • Health Policy
  • Humans
  • Mutation
  • National Health Programs*
  • Population Surveillance
  • Practice Guidelines as Topic
  • Program Development
  • Program Evaluation
  • Treatment Outcome
  • Viral Load
  • World Health Organization*


  • Anti-Retroviral Agents