Resistance to HIV drugs is rising, according to the largest analysis ever undertaken and reported for World Aids Day.
A report out today (1 December 2017) reveals that resistance to HIV drugs is approaching and exceeding 10% among people who are about to start or reinstate first-line antiretroviral therapy.
The study, led by researchers at University College London (UCL), UK, and the World Health Organisation (WHO), found that not only is resistance to NNRTIs – one of the main first-line drugs – growing, those who show signs of developing drug resistance were more likely to have previously been exposed to antiretroviral drugs, often during pregnancy.
Professor Ravindra Gupta, UCL Infection & Immunity, and study’s lead author, said: “Our findings show the importance of improving how we monitor drug resistance, and suggest we should review which drugs are included in first-line therapies.”
In the study, which was funded by the Bill & Melinda Gates Foundation and WHO and published in The Lancet Infectious diseases, researchers gathered 358 datasets, including data from 56,044 adults across 63 low- to middle-income countries who began first-line therapy for HIV from 1996 and 2016.
They found that from 2001-2016 the odds of drug resistance in low- to middle-income countries across Sub-Saharan Africa, Latin America and Asia increased. The increase in NNRTI resistance was greatest in Eastern Africa, which saw a 29% annual increase, and in Southern Africa, where there was a 23% annual increase.
Drug resistance was found to be highest in Southern Africa, where 11.1% of people beginning first-line therapy had a virus with NNRTI drug-resistant mutations, compared to 10.1% in Eastern Africa, 7.2% in Western/Central Africa, and 9.4% in Latin America.
People starting therapy who self-report previous use of antiretroviral drugs were also more likely to carry resistant virus, and are at greater risk of virological failure.
Prof Gupta said: “Many people develop drug resistance after being treated by antiretroviral drugs if they stop taking their medication – often due to personal reasons, difficulty accessing treatment providers, or drug supply issues that are common in low-income regions.
“When these individuals restart treatment at a later date, they are less likely to respond to therapy and may pass on the drug-resistant strains to other people.”
The researchers warn that if drug resistance to NNRTIs exceeds 10% among people starting therapy it could result in 890,000 more AIDS deaths and 450,000 more infections in Sub-Saharan Africa alone before 2030.
In July this year, WHO published a HIV drug resistance report, based on drug resistance national surveys conducted in 11 countries in Africa, Asia and Latin America. It found that in six of the 11 countries surveyed, over 10% of people starting HIV treatment had drug resistant strains.
The five-year Global Action Plan calls on all countries and partners to join efforts to prevent, monitor and respond to HIV drug resistance.
Ravindra Gupta et al. HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis. The Lancet Infectious Diseases 1 December 2017. [abstract]
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