Antiretroviral drugs are increasingly being provided to patients living with the human immunodeficiency virus (HIV) in developing countries. Experience gained in Europe and North America has shown that the use of these drugs dramatically reduced mortality but is also associated with the emergence of drug-resistant HIV. Surveillance of drug resistant HIV in developing countries is therefore important, as the spread of a resistant virus could seriously hamper the fight against the AIDS pandemic.
The EU Fifth Framework Programme (FP5)-funded Strategy To Control Spread of HIV Drug Resistance, (SPREAD) network has gained a leading role in the area of surveillance of HIV drug resistance. Within UNITE-MORE, SPREAD will closely co-operate with the World Health Organization (WHO) to support the establishment of a uniform global network for HIV drug resistance surveillance.
The activities of UNITE-MORE can be divided into three main areas: (i) supporting the selection, and training of national HIV drug resistance surveillance teams in Eastern Europe, Africa, Asia and Latin-America, (ii) supporting the development of common clinical laboratory standards for the monitoring of HIV resistance (standard protocols, sample collection methods, and standard data storage and analysis), and (iii) supporting the training and operational activities of the country HIV drug resistance surveillance teams.
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The use of antiretroviral therapy has dramatically reduced mortality in patients living with HIV in countries with access to antiretroviral drugs. But only a limited proportion of HIV-infected patients in developing countries have access to antiretrovirals. To address this emergency, the WHO established its '3 by 5 initiative'; getting 3 million people on treatment by 2005.
Unfortunately, the provision of antiretrovirals in Europe and North America has resulted in the rapid emergence of drug resistant HIV, which frequently limits the benefits of antiretroviral treatment. The spread of drug-resistant populations of the virus in developing countries may render current ART less effective in the longer term. In other words, if the further spread of HIV drug resistance is not controlled, the fight against the AIDS pandemic could be seriously hampered.
Confronting the global emergency caused by HIV therefore necessitates a global uniform effort in HIV resistance surveillance with common clinical laboratory standards, leading to comparable global data on the prevalence, transmission and trends of HIV drug resistance.
UNITE-MORE aims to support the establishment of a uniform global network for HIV drug resistance surveillance, including standardized laboratory procedures and quality assurance programmes. The network could provide governments, scientists and policy-makers with relevant and comparable global data on the prevalence, transmission and trends of HIV drug resistance. UNITE-MORE will contribute to the objectives of the European Research Area (ERA), notably the opening up of ERA to third countries (specifically poor-resource countries), increased networking at the global level and raising the scientific and technological profile of Europe.
UNITE-MORE will support the establishment of a uniform global network for HIV drug resistance surveillance. This will include standardized laboratory procedures and quality assurance programmes. UNITE-MORE will act as a key force in global efforts on HIV drug resistance surveillance using existing European activities under SPREAD, and WHO Global HIV Drug Resistance programme within the '3 by 5 initiative' as a strong and solid basis. The actions proposed by UNITE-MORE will have a strategic impact on national HIV resistance surveillance teams across the globe.
In addition, by setting up country level networks, UNITE-MORE will contribute to the dissemination of knowledge across countries in four continents.
After its establishment, the surveillance network could provide governments, scientists and policy-makers with relevant and comparable global data on the prevalence, transmission and trends of HIV drug resistance. Further, the established network could provide a resource for addressing important questions of HIV drug resistance patterns and spread related to HIV genetic diversity.