Evolutionary dynamics of complex networks of HIV drug-resistant strains: the case of San Francisco.

TitleEvolutionary dynamics of complex networks of HIV drug-resistant strains: the case of San Francisco.
Publication TypeJournal Article
Year of Publication2010
AuthorsSmith, RJ, Okano JT, Kahn JS, Bodine EN, Blower S
JournalScience (New York, N.Y.)
Volume327
Issue5966
Pagination697-701
Date Published2010 Feb 5
ISSN1095-9203
KeywordsAnti-HIV Agents, Antiretroviral Therapy, Highly Active, Computer Simulation, Disease Outbreaks, Drug Resistance, Multiple, Viral, Drug Resistance, Viral, Drug Therapy, Combination, Evolution, Molecular, Forecasting, HIV, HIV Infections, HIV Protease Inhibitors, Homosexuality, Male, Humans, Male, Models, Statistical, Monte Carlo Method, Probability, Reverse Transcriptase Inhibitors, San Francisco
Abstract

Over the past two decades, HIV resistance to antiretroviral drugs (ARVs) has risen to high levels in the wealthier countries of the world, which are able to afford widespread treatment. We have gained insights into the evolution and transmission dynamics of ARV resistance by designing a biologically complex multistrain network model. With this model, we traced the evolutionary history of ARV resistance in San Francisco and predict its future dynamics. By using classification and regression trees, we identified the key immunologic, virologic, and treatment factors that increase ARV resistance. Our modeling shows that 60% of the currently circulating ARV-resistant strains in San Francisco are capable of causing self-sustaining epidemics, because each individual infected with one of these strains can cause, on average, more than one new resistant infection. It is possible that a new wave of ARV-resistant strains that pose a substantial threat to global public health is emerging.

Alternate JournalScience