TREAT Asia Workshop Explores Drug Resistance
by Rami Kantor, M.D.
July 2005—Antiretroviral therapy is challenging and complicated in large part because the evolution of viral resistance to drugs can diminish virologic response and limit treatment options. Although complex, incorporating drug resistance into patient care has been shown to be effective and can help inform the selection of initial and subsequent treatment regimens. Yet while most epidemiologic, pathogenetic, and clinical studies of drug resistance have been confined to subtype B viruses that are most common in the United States, Europe, and Australia, other subtypes (e.g. subtype C in India and the AE and BC recombinants in Thailand and China) predominate in Asia.
To review what is known about HIV drug resistance, discuss resistance monitoring and surveillance in Asia, and offer hands-on training to clinicians and researchers, TREAT Asia held a two-day workshop at Chulalongkorn University in Bangkok, 11–12 October 2004. The workshop was led by Kevin Frost, director of TREAT Asia, and was hosted by Dr. Vilai Chentanez, associate dean for research affairs at Chulalongkorn University. Clinicians, lab directors, virologists, microbiologists, statisticians, research assistants, and students attended from 12 countries in Asia. Most were affiliated with hospitals and academic institutions, while others came from governmental and nongovernmental organizations, ministries of health, and public or private clinics and laboratories.
Plenary sessions covered topics such as the fundamentals of drug resistance and global HIV diversity, and the experience of drug resistance among different countries in Asia and among selected TREAT Asia sites. Dr. Donald Sutherland of the World Health Organization (WHO) reviewed the WHO’s plans for global resistance surveillance and monitoring. Additional plenary presentations included overviews of the TREAT Asia Observational Database and the Stanford HIV Sequence Database; suggested models for external quality assurance for resistance testing and resistance surveillance; and an overview of the HIV Resistance Response Database Initiative.
In the clinical track on the first day of the workshop, faculty and attendees discussed guidelines for drug resistance testing and therapeutic strategies for minimizing resistance, followed by case presentations involving drug resistance issues in patient care. The laboratory track took place in a 50-computer room, which allowed for live demonstrations and hands-on learning. The sessions covered basic sequence analysis and phylogenetic, subtyping, and quality control principles. Participants also learned about analyzing, understanding, and combining drug resistance results using online databases.
The workshop concluded with a discussion of operational plans for incorporating drug resistance into the TREAT Asia agenda, including financial and management issues, strategies for quality control implementation, and expansion of current capabilities.
Workshop faculty were: Dr. Donald Sutherland, WHO, Geneva; Dr. Praphan Phanuphak, Dr. Kiat Ruxrungtham, and Dr. Sunee Sirivichayakul, Chulalongkorn University, Thailand; Dr. Matthew Law and Dr. Philip Cunningham, University of New South Wales, Australia; Dr. Brendan Larder, HIV Resistance Response Database Initiative, England; and Dr. David Katzenstein, Dr. Robert Shafer, and Dr. Rami Kantor, Stanford University, USA.
Dr. Kantor (formerly of Stanford University) is assistant professor of medicine (research) at Brown University, Providence, Rhode Island.