THE EMERGING GENETIC DIVERSITY OF HIV - THE IMPORTANCE OF GLOBAL SURVEILLANCE FOR DIAGNOSTICS, RESEARCH, AND PREVENTION

The discovery of highly divergent strains of human immunodeficiency vi rus (HIV) not reliably detected by a number of commonly used diagnosti c tests has underscored the need for effective surveillance to track H IV variants and to direct research and prevention activities. Pathogen s such as HIV that mutate extensively present significant challenges t o effective monitoring of pathogens and to disease control, To date, r elatively few systematic large-scale attempts have been made to charac terize and sequence HIV isolates. For most of the world, including the United States, information an the distribution of HIV strains among d ifferent population groups Is limited. We describe herein the implicat ions resulting from the rapid evolution of HIV and the need for system atic surveillance integrated with laboratory science and applied resea rch. General surveillance guidelines are provided to assist in Identif ying population groups for screening, in applying descriptive epidemio logy and systematic sampling, and in developing and evaluating efficie nt laboratory testing algorithms. Timely reporting and dissemination o f data is also an important element of surveillance efforts, Ultimatel y, the success of a global surveillance network depends on collaborati on and on coordination of clinical laboratory, and epidemiologic effor ts.