ARV resistance rises

HIV patients are experiencing virologic failure to second-line ART

AN INCREASING number of HIV patients in the Western Cape and the rest of the country are experiencing resistance to second-line antiretroviral therapy (ART).

This comes from the fifth South African National HIV Prevalence, Incidence, Behaviour and Communication survey conducted last year by the Human Sciences Research Council.

The survey found resistance to any ARVs in 27.4% of the respondents who were virally unsuppressed.

Resistance to one drug class was found among 18.9% of the respondents and 7.8% had resistance to two drug classes that constitute first-line therapy used in South Africa, while a smaller proportion (0.5%) had resistance to second-line regimens.

Drug resistance was found in 55% of respondents who were on treatment and not virally suppressed, as well as in 75% of those who had stopped taking treatment.

Furthermore, resistance was found in 15% of respondents who reported no previous exposure to ARVs.

The levels of drug resistance were the same among males and females, and among children aged 0-14 years, the youth aged 15-24 years and adults.

Provincial Department of Health spokesperson Mark van der Heever said: “An increasing number of patients in South Africa and the Western Cape are experiencing virologic failure to second-line ART and those who develop resistance to protease inhibitors will require third-line ART.

“About 15% of patients on second-line ART will require to change to third-line ART because of resistance. However, the majority of patients in the province are on first-line ART.”

He said patients resistant to treatments are able to access third-line ART.

“With the availability of the thirdline ART, patients who are failing second-line ART have an option to change treatment, which will suppress the virus if taken correctly. It works by suppressing the resistant virus.

“It is important that patients remain adherent to their treatment and that they are supported in their efforts to manage their disease and take life-long therapy everyday.”

Dr Gillian Hunt, an expert on HIV drug resistance, from the National Institute of Communicable Diseases and co-investigator of the survey said: “The results from this study are consistent with those reported in the 2017 World Health Organisation HIV drug resistance report, where levels of resistance in persons failing first-line treatment are between 50-90%, and more than 10% in persons starting first-line treatment in southern African countries. In addition, this research has shown that high proportions of patients that are no longer in care have resistance.”

UCT professor Thomas Rehle, who was involved in the design of the study said: “Understanding the current levels of HIV drug resistance and its potential impact on the HIV epidemic is especially crucial for South Africa, which has the largest number of HIV-infected individuals on ARVs.”

Resistance was found in 15% of respondents who reported no previous exposure to ARVs