Resistance to ARVs increasing
More people needing third-line therapy as second-line fails
AN INCREASING number of HIV patients in the Western Cape and other parts of South Africa are experiencing resistance to second-line antiretroviral therapy (ART).
This was revealed by the fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, conducted last year by the Human Sciences Research Council (HSRC).
The survey found resistance to ARVs in 27.4% of the respondents who were not virally suppressed.
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 to 14 years, youths aged 15 to 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 antiretroviral therapy (ART), and those who develop resistance to protease inhibitors (PI) will require third-line ART.
“According to literature, about 15% of patients on second-line ART will need 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 who were resistant to second-line treatment were able to access third-line ART.
“With the availability of thirdline ART, patients who are failing second-line ART have the option to change treatment, which will suppress the virus if taken correctly. It works by suppressing the resistant virus.”
Dr Gillian Hunt, an expert on HIV drug resistance from the National Institute for 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% and 90%, and more than 10% in persons starting first-line treatment in southern African countries.”
UCT Professor Thomas Rehle, who was involved in designing 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.”