Drug resistance a major setback to HIV fight
Author: Amy Green
More and more countries are reaching the “threshold” of resistance to the most commonly-used HIV drugs which could “undermine global progress in treating and preventing HIV”, according to the World Health Organisation (WHO). HIV drug resistance occurs when individuals do not take their medicines as prescribed. This gives the virus a chance to mutate to the point where the medication no longer works to suppress it – allowing it to multiply and make a person open to infections that can make them sick.
When HIV activist Prudence Mabele died, her CD4 count was only 14, although she had been on ARVs for many years. Veteran HIV activist Zackie Achmat revealed over the weekend that Mabele “regularly joked that she interrupted her antiretroviral treatment”.
“‘Treatment holidays’ are dangerous and most probably were the cause of her premature death,” said Achmat.
The WHO recommends that when 10% of people on the first-line drug regimen become resistant, this could threaten the fight against HIV and countries should switch to a different first-line regimen.
Six out of 11 countries surveyed in Africa, Asia and Latin America have reached this threshold and should change their first-line regimen, according to a WHO report released last week.
“We would like to raise attention to the problem and we would like more data to see if it’s a generalised problem in the African context and other contexts. And we think it is – because if we look at not only WHO surveillance data but also from other research, we are seeing resistance has reached the 10% level,” the WHO’s Dr Silvia Bertagnolio told Health-e News from the International Aids Society (IAS) Conference on HIV Science in Paris.
While the report does not include national data from South Africa, Professor Francois Venter from the Wits Reproductive Health and HIV Institute said that reports from around the country indicate we have also surpassed this 10% threshold.
According to the WHO’s Dr Meg Doherty, up to 40% of South African patients who stopped taking their ARVs only resumed treatment when they were very sick and “are more likely to die if we don’t intervene very quickly”.
Doherty said that in addition to considering changing first-line regimens, resistance could be tackled by increasing efforts to help patients to adhere to treatment, as it is very difficult for them to take pills every day for the duration of their entire lives.
“Pill fatigue is an issue, which is why it’s important to have a good client-clinician relationship and understand if a person needs to take a break and to do that openly and identify when and where the person can come back into care,” Doherty said. “Right now we know people come in and out of care all the time.
“But there’s been a lot of great progress. We have 19.5 million people on therapy globally and South Africa is leading the effort. It has the greatest amount of work to do and has been a leader in making treatment happen for the millions of people living in the country. What we want to do is ensure that we are not keeping our head in the sand, and address resistance before it becomes a major challenge.” – Health-e News