Spreading of multi-drug resistant HIV a scary reality

The spread of drug-resistant HIV in SA is at a point where about one in five adults and one in two infants who become infected will be resistant to one class of drugs used in the HIV treatment plan.

Not taking treatment diligently can also cause people to develop multidrug-resistant HIV. Drug-resistant HIV complicates treatment plans and there are less drug options for these patients. On top of this, there are social and economic constructs fuelling the spread of drug-resistant HIV. While I believe we can always find ways to treat HIV, no matter how big the problem, we are at a point where current treatment options have become more limited. HIV is a complex, potent disease and when it mutates, it produces different variations of itself. This can lead to multiple drug-resistant strains in the person’s body. Drugs that previously targeted a person’s HIV fail to fight these new strains, which means they cannot prevent the new strains from multiplying. Drug resistance develops if a patient does not take their daily dose of medication. This gives the virus opportunity to mutate in the presence of the medication. Over time, this treatment fails and the drug-resistant virus becomes the dominant virus in the body. There are tests to see if patients have this virus but, as the country with the highest infection rate in the world, and the cheapest test costing about R2,000, this is reserved for patients failing second-line treatment in the public health sector.

This doesn’t just complicate the treatment plan for the patient, it presents a scary reality when it comes to transmission because this drug-resistant virus can be passed on to drug users sharing needles as well as sexual partners or from a mother to her child during pregnancy or breastfeeding. This makes treatment plans for the nearly eight million people who are HIV positive much more intricate. Children are always the most vulnerable. We have made great strides in reducing mother-to-child transmission to below 2%. However, of the children who are born HIVinfected, one out of two are born with the drug-resistant virus. When it comes to UNAID’s 9090-90 target, SA is doing very well in meeting the first target of getting 90% of people with HIV knowing their status by 2020. However, when it comes to treatment – we are struggling to get people onto, and staying on treatment. Social issues around the virus are rife. Almost a third of the patients I treat did not stay on treatment. About 40% of people who defaulted and started again have developed drug-resistant HIV.

We are sitting with a problem where patients do not disclose they were previously on treatment because they think they might get into trouble or be denied treatment. Socioeconomic realities such as violence, poverty and gender-based inequality also contribute to spreading drug-resistant HIV. HIV prevalence among young women in SA is nearly four times greater than for men their age. Many are going into transactional sexual relationships with older men, in exchange for material goods. “Blessers” have multiple “blessees”, creating an environment for drugresistant HIV to spread and thrive. Until these issues are beaten, the HIV battle will not be won. There definitely is hope because drugs are improving all the time. People should not be afraid to be tested and start treatment. You can have a normal life expectancy if you start treatment early. In fact, in some cases infected people live longer because they are well looked after, and more aware of their health. Professor Rossouw is deputy director of the University of Pretoria’s Centre for Ethics and Philosophy of Health Sciences