An increasing trend of resistance to drugs that fight human immunodeficiency virus (HIV) could undermine global progress in treating and preventing the infection if early and effective action is not taken, warns the World Health Organization (WHO).
The WHO HIV drug resistance report 2017 shows that in six of the 11 countries surveyed in Africa, Asia, and Latin America, more than 10% of people starting antiretroviral therapy had a strain of HIV that was resistant to some of the most widely used HIV medicines. Once the threshold of 10% has been reached, WHO recommends those countries urgently review their HIV treatment programs.
“Antimicrobial drug resistance is a growing challenge to global health and sustainable development,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “We need to proactively address the rising levels of resistance to HIV drugs if we are to achieve the global target of ending AIDS by 2030.”
HIV drug resistance develops when people do not adhere to a prescribed treatment plan, often because they do not have consistent access to quality HIV treatment and care. Individuals with HIV drug resistance will start to fail therapy and may also transmit drug-resistant viruses to others. The level of HIV in their blood will increase, unless they change to a different treatment regimen, which could be more expensive—and, in many countries, still harder to obtain.
Of the 36.7 million people living with HIV worldwide, 19.5 million people were accessing antiretroviral therapy in 2016. The majority of these people are doing well, with treatment proving highly effective in suppressing the HIV virus. But a growing number are experiencing the consequences of drug resistance.
WHO is therefore issuing new guidelines to help countries address HIV drug resistance. These recommend that countries monitor the quality of their treatment programs and take action as soon as treatment failure is detected.
"We need to ensure that people who start treatment can stay on effective treatment, to prevent the emergence of HIV drug resistance," said Dr. Gottfried Hirnschall, Director of WHO’s HIV Department and Global Hepatitis Program. “When levels of HIV drug resistance become high we recommend that countries shift to an alternative first-line therapy for those who are starting treatment.”
Increasing HIV drug resistance trends could lead to more infections and deaths. Mathematical modelling shows an additional 135 000 deaths and 105 000 new infections could follow in the next five years if no action is taken, and HIV treatment costs could increase by an additional $650 million during this time.
A new five-year Global Action Plan calls on all countries and partners to join efforts to prevent, monitor, and respond to HIV drug resistance and to protect the ongoing progress toward the Sustainable Development Goal of ending the AIDS epidemic by 2030. In addition, WHO has developed new tools to help countries monitor HIV drug resistance, improve the quality of treatment programs, and transition to new HIV treatments, if needed.
Source: WHO; July 20, 2017.