Alarming Surge in Drug-Resistant HIV Uncovered | Virus World | Scoop.it
From www.scientificamerican.com - July 30, 2019 5:30 PM

Health authorities have uncovered an alarming surge in resistance to crucial HIV drugs. Surveys by the World Health Organization (WHO) reveal that, in the past 4 years, 12 countries in Africa, Asia and the Americas have surpassed acceptable levels of drug resistance against two drugs that constitute the backbone of HIV treatment: efavirenz and nevirapine. 

 

The WHO conducted surveys from 2014 to 2018 in randomly selected clinics in 18 countries, and examined the levels of resistance in people who had started HIV treatment during that period.  More than 10% of adults with the virus have developed resistance to these drugs in 12 nations (see ‘Resistance rises’). Above this threshold, it’s not considered safe to prescribe the same HIV medicines to the rest of the population, because resistance could increase. Researchers published the findings this month in WHO report. Overall, 12% of women surveyed had a drug-resistant form of HIV, compared with 8% of men. Particularly concerning, says the report, is the high level of resistance in infants with HIV in sub-Saharan Africa. Between 2012 and 2018, about one-half of newly diagnosed infants in nine of the countries in this region had a form of HIV that was resistant to efavirenz, nevirapine or both.

 

The prevalence of resistance in people who restarted efavirenz and nevirapine after interrupting treatment was much higher (21%) than in first-time users (8%).  People living with HIV might go on and off the drugs for several reasons. Stigma plays a huge part, says Bertagnolio; they might not want to be seen picking up their medicines. Drug shortages at clinics could also contribute, the report noted. 

 

In response to the evidence, the WHO has recommended that countries use dolutegravir, which is more effective and tolerable than other therapies, as the go-to HIV drug. The likelihood that the virus will develop mutations and, eventually, resistance is lower with dolutegravir than with other antiretrovirals, says Roger Paredes, an infectious-disease physician at the Germans Trias i Pujol University Hospital in Barcelona, Spain. “We have to encourage a worldwide transition to dolutegravir,” he adds.

 

Original article published in Nature in July 30, 2019:

https://doi.org/10.1038/d41586-019-02316-x

WHO report available at:

https://www.who.int/hiv/pub/drugresistance/hivdr-report-2019/en/