Variant, Atypical, and Resistant HIV Surveillance Project (VARHS)
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What is drug resistance surveillance (VARHS)? |
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Definition and objectives: Variant, atypical and resistant HIV surveillance (VARHS) is an expanded HIV/AIDS surveillance activity funded by the Centers for Disease Control and Prevention (CDC). The objectives of VARHS are to monitor the frequency of important antiretroviral resistance mutations, follow the outcomes of those with and without mutations, and measure the prevalence of different HIV-1 viral strains/types.
Methods: VARHS uses genotypic tests to determine viral subtype and the presence of any drug resistant mutations. Genotype results from clinical practice are collected from participating laboratories. Inclusion criteria for VARHS are a recent confidential HIV test, being newly diagnosed with HIV (no previous positive tests more than 90 days prior), and being antiretroviral-naïve. Confidentiality of data is of the utmost importance and is protected with a level of security exceeding HIPAA standards.
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Latest statistics on drug resistance as of 6/2012 |
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Completeness of VARHS, King County, by diagnosis year
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2004-2005
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2006-2007
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2008-2009
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2010-2011
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| Newly diagnosed HIV cases with genotype within 3 months of diagnosis included in VARHS |
38%
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60%
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65%
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67%
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Prevalence of high-level antiretroviral drug resistance and HIV-1 subtypes among newly diagnosed HIV cases in King County, by diagnosis year
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| High-level resistance |
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| Overall |
12%
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10%
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13%
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14%
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| NRTI |
3%
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4%
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<1%
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<1%
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| NNRTI |
9%
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9%
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11%
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13%
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| PI |
4%
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2%
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2%
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1%
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| 2 or 3 classes |
4%
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2%
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<1%
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<1%
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| HIV-1 subtype |
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| B |
90%
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89%
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92%
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90%
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| C |
5%
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4%
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3%
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3%
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| Other |
6%
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6%
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5%
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7%
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Where is VARHS happening? |
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Five local and regional laboratories are submitting genotypic test results that have been ordered by Washington State health care practitioners. Other regions around the country that participate in VARHS include Colorado, Chicago, Connecticut, Florida, Los Angeles, Michigan, New York City, South Carolina, and Texas.
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Who is eligible for VARHS? |
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All individuals newly and confidentially diagnosed with HIV infection who are antiretroviral naïve are included in VARHS. Thus, people with anonymous HIV tests, those known to be HIV infected for more than 90 days and/or those who have a history of antiretroviral use are not included.
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What is multi-class drug resistance (MDR)? |
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Multi-class drug resistance (MDR) is defined as high level drug resistance in more than one antiretroviral drug class. The three classes which are routinely evaluated for resistance are protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI) and non-nucleoside reverse transcriptase inhibitors (NNRTI). MDR does not necessarily accelerate disease progression, but high level resistance to more than one drug class may lead to reduced treatment options that can be expensive and difficult to maintain.
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Recent multi-class-drug resistant cluster among methamphetamine-using men who have had sex with men (MSM) |
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In 2006 and 2007, strains of genetically similar MDR-HIV were identified in seven newly diagnosed ARV-naïve individuals and two treatment-experienced individuals. All nine were men who had sex with men (MSM) and all reported recent use of methamphetamine and sex with multiple, mostly anonymous sex partners. All had resistance tests showing resistance to most protease inhibitors, most non-nucleoside reverse transcriptase inhibitors, and varying levels of resistance to nucleoside reverse transcriptase inhibitors. A manuscript describing the epidemiology and phylogenic analysis of this cluster was published in 2008.
In February 2007, Public Health - Seattle & King County issued a press release regarding this cluster.
This press release resulted in wide coverage in newspapers, radio, and TV. Via the news media, Public Health attempted not only to educate people about the cluster and drug-resistant HIV, but also to encourage HIV prevention. Later that same month Public Health conducted a survey of 325 sexually active men who have sex with men (MSM). Over half (57%) of the MSM surveyed had heard about the MDR cluster, with 90% of these men recalling key points. Almost all (98%) of the MSM interviewed agreed it was important to release information on this cluster to the media.
Other VARHS sites:
Local:
- Markovitz AR, Thibault CS, Brandauer PW, Buskin SE. Primary antiretroviral drug resistance in newly-human immunodeficiency virus-diagnosed individuals testing anonymously and confidentially. Microb Drug Resist. 2011 Mar 7. [E pub ahead of print] Pubmed PMID: 213811964.
- Ellis GM, Page LC, Burman BE, Buskin S, Frenkel LM. Increased Detection of HIV-1 Drug Resistance at Time of Diagnosis by Testing Viral DNA With a Sensitive Assay. J Acquir Immune Defic Syndr. 2009 Apr 24.
- Kahle EM, Barash AE, Page LC, Lansky A, Jafa K, Sullivan PS, Buskin SE. Evaluation of the Impact of News Coverage of an HIV Multiclass Drug–Resistant Cluster in Seattle, Washington AJPH 2009 Apr;99 Suppl 1:S131-6.
- Buskin SE, Ellis GM, Pepper GG, Frenkel LM, Pergam SA, Gottlieb GS, Horwitch C, Olliffe JF, Johnson K, Shalit P, Heinen C, Schwartz M, Wood RW. Transmission cluster of multiclass highly drug-resistant HIV-1 among 9 men who have sex with men in Seattle/King County, WA, 2005-2007. J Acquir Immune Defic Syndr. 2008 Oct 1;49(2):205-11.
- Buskin SE, Zhang S, Thibault CS. Prevalence of and Viral Outcomes Associated with Primary HIV-1 Drug Resistance. Open AIDS Journal. Bentham Science Publishers. In press. Expected publication date July, 2012.
- HIV/AIDS Epidemiology Unit, Public Health – Seattle & King County and the Infectious Disease Assessment Unit, Washington State Department of Health. HIV/AIDS Epidemiology Report, Second Half 2003 through First Half 2011.
National:
- Wheeler WH, Ziebell RA, Zabina H, Pieniazek D, Prejean J, Bodnar UR, Mahle KC, Heneine W, Johnson JA, Hall HI; Variant, Atypical, and Resistant HIV Surveillance Group. Prevalence of transmitted drug resistance associated mutations and HIV-1 subtypes in new HIV-1 diagnoses, U.S.-2006. AIDS. 2010 May 15;24(8):1203-12. PubMed PMID: 20395786.
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