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Variant, Atypical, and Resistant HIV Surveillance Project (VARHS)

What is drug resistance surveillance (VARHS)?

Objective:  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.

Latest statistics on drug resistance as of 5/2011

Completeness of VARHS, King County, by diagnosis year
.
2003-2004
2005-2006
2007-2008
2009-2010
Newly diagnosed HIV cases with genotype within 3 months of diagnosis included in VARHS
16%
40%
60%
73%


Prevalence of high-level antiretroviral drug resistance and HIV-1 subtypes among newly diagnosed HIV cases in King County, by diagnosis year
.

2003-2004
N=107

2005-2006
N=249

2007-2008
N=379

2009-2010
N=458
High-level resistance
Overall
10%
11%
12%
13%
NRTI
4%
3%
2%
1%
NNRTI
9%
8%
10%
12%
PI
1%
3%
2%
2%
2 or 3 classes
3%
3%
1%
1%
HIV-1 subtype
B
93%
90%
89%
91%
C
2%
3%
6%
2%
Other
5%
6%
5%
7%

Where is VARHS happening?

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.

Who is eligible for VARHS?

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.

What is multi-class drug resistance (MDR)?

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.

Recent multi-class-drug resistant cluster among methamphetamine-using men who have had sex with men (MSM)

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.