The HIV drug “cocktail” has transformed AIDS from a fatal disease to a manageable condition. Unfortunately, HIV can become resistant to these drugs, leading to the development of full-blown AIDS in the patient and increasing the chances of further transmission of the virus.
Drs. Richard Harrigan and Julio Montaner’s research team is developing two tests that will allow rapid assessment of multi-class HIV drug resistance personalized to an individual’s DNA and the DNA of the virus. These tests will replace multiple, less sensitive tests to reduce needless exposure of inadequate therapies. This should result in reduced costs and improved chances of controlling infection early on. Since the project began, one test has completed development (Amplicon assay) and is already in use.
Lifetime drug costs for HIV are between $250,000 and $500,000, but there are numerous multipliers of the economic impact of an HIV infection. Nations with high HIV-infection rates see the significance of those impacts on GDP to a point of unsustainability.
The project has also delivered on its goal to develop real-time surveillance systems for monitoring drug resistance to provide an early warning of geographic or population “hotspots” where resistance rates are highest and the risk of transmission greatest. Daily reports of new cases are reviewed and this information is used to create monthly and quarterly phylogenetic reports to the BC Centre for Disease Control.
Reports showed a new emergence of a resistance cluster in 2014 sparking action by the Ministry of Health. Based on these findings, enhanced patient follow-up by Vancouver Coastal Health resulted in improved disease management in 7 of the 11 new resistant cases. Developing cases are monitored by the BCCDC and Vancouver Coastal Health in real-time.
Mathematical modeling suggests that implementing this pilot project in Vancouver’s Downtown East Side and Prince George could avert as many as 173 HIV infections in the first five years, which represents approximately $65 million in avoided lifetime HIV treatment costs.