Evolutionary Dynamics of Complex Networks of HIV Drug-Resistant Strains: The Case of San Francisco

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Science  14 Jan 2010:
DOI: 10.1126/science.1180556


Over the past two decades, HIV resistance to antiretrovirals (ARVs) has risen to high levels in the wealthier countries of the world 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. Using this model, we traced the evolutionary history of ARV resistance in San Francisco and predict the future dynamics. Using classification and regression trees, we have 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, as 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 significant threat to global public health is emerging.