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

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Science  05 Feb 2010:
Vol. 327, Issue 5966, pp. 697-701
DOI: 10.1126/science.1180556

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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.

  • * Present address: Department of Mathematics and Faculty of Medicine, University of Ottawa, Ottawa, K1N 6N5, Ontario, Canada.

  • These authors contributed equally to this work.

  • Present address: Department of Mathematics, University of Tennessee, Knoxville, TN 37996, USA.

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