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Rural Areas of the United States Continue to Grapple with Outbreaks of HIV

NOV 08, 2017 | CONTAGION® EDITORIAL STAFF
Outbreaks in rural areas may just be the tip of the iceberg when it comes to new fears on HIV. This is because, according to a new report, the virus is becoming increasingly resistant to the antiretroviral (ART) medications that are vital to treating (and preventing) the infection. Chris Beyrer, MD, professor of epidemiology with the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and lead author on the report stated in a press release that, “Current trends in HIV drug resistance are very concerning. Resistance levels have been found to be highest in ART-exposed infants and children, which is a real concern since children are already among the least-treated age group in many developing countries.”

About half of the world’s population of individuals with HIV (19.5 million) are currently being treated with ART, according to the press release.

This new report on increasing resistance will certainly put a major damper on hopes that the world will be able to hit the United Nations’ and World Health Organization’s 90-90-90 targets, which include eliminating AIDS as a public health threat by 2030, and ensuring that 90% of individuals who are infected with HIV have access to ART by 2020. According to Dr. Beyrer, accomplishing this will be, “enormously difficult. WHO and experts from the CDC acknowledged that ART effectiveness is increasingly at risk, with HIV drug resistance having shot up from just 11% in 2001 to 29% today.”

The main driver in this resistance is a familiar one: lack of adherence to the [ART] medication regimen, which enables the virus to mutate and develop resistance to the drugs.

What can be done?

“The research team advocates placing more focus on prevention by hastening the development of an effective vaccine and by ratcheting up the use of Truvada, the HIV prevention regimen also known as PrEP,” according to the press release. PrEP has been found to curb the risk of becoming infected with HIV up to 90%. In addition, the release states that Dr. Beyrer recommends “those already infected, but not yet treated, should be given access to newer types of ART cocktails, including drugs such as dolutegravir that have higher genetic barriers to resistance." At this time, experts are reporting that resistance to PrEP is seen as “very rare.”

The bottom line is that the health care community needs to remain vigilant in surveillance of HIV infections, connecting individuals at-risk and infected to care as soon as possible, and conducting ongoing research on the virus and effective medication to treat and prevent infection.
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