Drug re­sis­tance a ma­jor set­back to HIV fight

The Star Early Edition - - NEWS - 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 first­line 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 first­line 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

PIC­TURE: SIPHIWE SIBEKO / REUTERS

MED­I­CA­TION: HIV drug re­sis­tance oc­curs when in­di­vid­u­als do not take their medicines as pre­scribed.

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