As HIV Drug Resistance Grows, WHO Calls for Global Action

In a statement released yesterday, July 20, 2017, the World Health Organization (WHO) alerted countries around the world to the growing threat of resistance to HIV drugs. WHO learned of this alarming trend through national surveys, and the results are presented in the WHO HIV drug resistance report 2017.

“6 of the 11 countries surveyed in Africa, Asia and Latin America, [showed that] over 10% of people starting antiretroviral therapy had a strain of HIV that was resistant to some of the most widely used HIV medicines,” according to the report. Once these countries reach a threshold of 10%, WHO advises that they should “urgently review their HIV treatment programs.”

WHO Director-General, Tedros Adhanom Ghebreyesus, MD, commented on this growing threat in the alert, stating, “Antimicrobial drug resistance is a growing challenge to global health and sustainable development. 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.”

WHO stressed in their statement that “mathematical modelling shows [that] an additional 135,000 deaths and 105,000 new infections could follow in the next 5 years if no action is taken, and HIV treatment costs could increase by an additional US$ 650 million during this time.”

HIV can develop resistance to drugs when individuals do not adhere to their prescribed treatment plan, according to the statement. This lack of adherence is often the result of not having consistent access to “quality HIV treatment and care.” Those individuals who do have resistance to the HIV drugs often 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,” something that may require more expensive drugs that individuals in low- and mid-income countries may have a harder time obtaining.

A total of 36.7 million individuals are living with HIV worldwide, and, according to available data, 19.5 million of these individuals “were accessing antiretroviral therapy in 2016.” Although the majority of these individuals are reported to be responding well to treatment, additional reports of drug resistance are continuing to occur. To this end, WHO will be issuing new guidelines “to help countries address HIV drug resistance,” according to the statement. Those countries where resistance has been detected are urged to reassess their HIV treatment programs and take immediate action if treatment failure is detected.

“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,” said Gottfried Hirnschall, MD, Director of WHO’s HIV Department and Global Hepatitis Programme in the statement.

Collaboration with major partners from all corners of the world is going to be required to tackle the threat of HIV drug resistance. Therefore, WHO is releasing a new 5-year Global Action Plan that will, “call on all countries and partners to join efforts to prevent, monitor, and respond to HIV drug resistance and to protect the ongoing progress towards the Sustainable Development Goal of ending the AIDS epidemic by 2030.”

WHO also announced that they are developing “new tools to help countries monitor HIV drug resistance, improve the quality of treatment programs, and transition to new HIV treatments, if needed.”

The new guidelines and reports will be presented at the upcoming International AIDS Society Conference in Paris: 9th IAS Conference on HIV Science.

In addition, WHO is also releasing 7 Key Guidelines and normative tools, as follows :

1. A new information note on point-of-care early infant diagnosis assays to support the timely detection of children with HIV.
2. The results of “STAR-self-testing in Africa” an implementation research effort, together with a new landscape report on rapid diagnostic tests for HIV self-testing.
3. A prioritized research agenda for children and adolescents to address low treatment scale-up and quality care for this group.
4. New guidelines on advanced HIV disease and rapid initiation of ART recommending screening, treatment and prophylaxis for major opportunistic infections (such as tuberculosis and cryptococcal disease), and rapid initiation of ART and adherence support for people with advanced HIV.
5. A new report outlining how countries can provide differentiated care tailored services for different needs of patient groups.
6. A new technical update advising countries on what to consider when transitioning to a new treatment regimen, including dolutegravir.