HIV Drug Resistance: Refusing to Leave Without Putting Up a Fight

Years of transferring lab results from test tubes and Petri dishes out onto the dismal playing field of worldwide HIV infection has finally given us a one-up on the disease. Series and series of refinement to antiretroviral therapy (ART) and better prevention programs has indicated nothing but a dwindling battle against the virus. But HIV is battling back. They are developing resistance to our meticulously-perfected drugs. Drug resistance is, as implied in the name, the ability of a virus to withstand the effects of a given antiretroviral drug attempting to prevent its replication; it will continue to replicate in the presence of the drug.

As the field of ART expands, some drug resistance is inevitable. Over the past decade, access to the treatment has dramatically increased; the 400 000 patients recorded as receiving ART in 2003 has skyrocketed to 6 million in 2010.  While this speaks wonders to technology and healthcare, it has also encouraged drug resistance. The increase has also been induced by insufficient knowledge among patients and health care workers, suboptimal adherence to treatment regiments, drug stock-outs, and inadequate patient monitoring devices. In the spirit of science, we have diligently developed a second-line regimen that can be administered to patients should they develop resistance to the first drug (first-line regimen). While there is nothing as comforting as a plan B, the second line is on average six times more expensive than the first line. To illustrate, where a first line costs $158, a second line would be $1025.

Costs aside, keeping drug resistance at bay is crucial to the success and sustainability of HIV treatment programmes. The World Health Organization (WHO) recognizes this importance, and has taken many an initiative to counter HIV drug resistance. They’ve led efforts to assess resistatnce at population level, using standardized methods over time and regions, namely their 2004 Global Strategy for the Prevention and Assessment of HIV Drug Resistance aimed at informing people of first and second line regimens of ART and supporting national HIV programmes in minimizing the emergence and transmission of resistance. WHO has also chaired HIVResNet, a network of upwards of fifty institutions, labs, and experts who are all accredited with HIV resitance testing status from WHO, in efforts to support surveillance and data analysis of drug resistance. Two thirds of such institutions are in Africa and Asia, where the virus is most prominent, so as to establish help as close to the problem as possible. The adamantly encourage countries to take measures to prevent HIV drug resistance, and in doing so improve the efficiency of their existing treatment programmes.

As with any effective initiative, not only must the problem at hand be addressed, but measures to take in the future must be outlined so as to uphold results. The WHO has outlined such measures to be made public and, hopefully, common knowledge. They stress the importance of continuing to ensure routine, population-based surveillance of HIV drug resistance. The implementation of strong national HIV drug resistance strategies is emphasized; partners and donors are encouraged to help countries develop such programmes. Their Treatment 2.0 initiative with UNAIDS to start the next phase of ART targets the formation of affordable and efficient programmes in developing countries. They understand that, even as a large scale organization, they can only reach so far, and therefore need to encourage others to also take action. HIV drug resistance has the potential to severely undermine years and years of effort – the upper hand that we’re only clinging to – to extend life-saving treatments to millions of people. We can’t let HIV back in the race.

Sources:

HIV Drug Resistance Fact Sheet

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