WHO’s latest report on HIV drug resistance gives a detailed picture of the extent of the growth in drug resistance and the steps countries are taking to ensure people receive effective drugs to treat and prevent HIV.
The report found that by 2020, 64% of target countries (countries with a high burden of HIV infection) had national action plans to prevent, monitor and respond to HIV drug resistance. These plans build on the Global HIV Drug Resistance Action Plan 2017-2021, a multi-stakeholder plan coordinated and published by WHO.
WHO encourages countries to monitor resistance and recommends that for people starting antiretroviral (ARV) drugs, anti-HIV drug resistance (PDR) is called pretreatment. WHO recommends that when the PDR to non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as nevirapine and efavirenz reaches a threshold of 10% for a study country, first-line anti-HIV therapy should be switched d emergency with a treatment regimen containing more robust dolutegravir. .
This report indicates that a growing number of countries are reaching the 10% resistance to ROP antiretroviral drugs against NNRTIs and that people who have been exposed to antiretroviral drugs are three times more likely to develop resistance to NNRTIs. the NNRTI drug class. These results underscore the need to accelerate the transition to treatment regimens containing dolutegravir in countries that continue to use NNRTI-based antiretroviral therapy.
Based on the most recent results from surveys in 10 countries in sub-Saharan Africa, nearly half of infants newly diagnosed with HIV have drug-resistant HIV before starting treatment. These results highlight the need to accelerate the current transition and the importance of using antiretroviral therapy with dolutegravir as early as possible in young children.
Since 2019, WHO recommends the use of dolutegravir as first and second-line treatment preferably for all population groups. It is more effective, easier to take, and has fewer side effects than other drugs currently in use. Dolutegravir also has a high genetic barrier to the development of drug resistance, thus supporting its durability and long-term effectiveness. Since the implementation of the surveys, many other countries have started to transition to treatment regimens containing dolutegravir, giving people a better treatment option and stepping up the fight against drug resistance.
Pre-exposure prophylaxis (PrEP) is an effective prevention option for HIV negative people at substantial risk of HIV infection as part of combination prevention approaches. Resistance is more likely to occur when PrEP is started in an acute undiagnosed HIV infection. As countries implement PrEP to prevent HIV infection, it should be accompanied by surveillance for HIV drug resistance in those infected despite PrEP use.
The report indicates that the number of countries achieving high levels of viral suppression (≥ 90%) increased from 33% in 2017 to 80% in 2020. Achieve high levels of viral load suppression in populations taking antiretroviral therapy prevents transmission of HIV, HIV- associated morbidity and mortality and prevents the emergence of resistance to HIV drugs.
The report also emphasizes the need for routine viral load monitoring and close follow-up of people with non-viral suppression, including diet change if necessary, to achieve favorable treatment outcomes. and long-term sustainable. In addition, ensuring the continued availability and accessibility of optimal drugs to treat HIV infections is essential to prevent drug resistance against HIV. These findings underscore the need to help countries proactively find durable solutions that are appropriate to local contexts and that can involve community members and civil society.
As the current Global HIV Drug Resistance Action Plan 2017-2021 draws to a close, the report recommends future global, national and national efforts to identify ongoing opportunities to prevent, monitor and respond to resistance to HIV drugs, in particular by adapting to the rapidly changing therapeutic landscape. and new models of service delivery. Minimizing the spread of resistance to HIV drugs is a critical aspect of the broader global response to antimicrobial resistance that requires coordinated action across all sectors of government and levels of society.
“This now regular HIVDR reporting and surveillance holds countries accountable – for providing high quality HIV treatment and care and targeted investments in antimicrobial resistance. In the future, we will expand our surveillance to new ARVs and to those that are dispensed as prevention and treatment agents – so that we can maintain our ARVs for the lifespan of people living with HIV, ”said Meg Doherty, Director of WHO’s Global HIV, Hepatitis and STIs Programs.
This report will be discussed during a webinar organized as part of Global Antimicrobial Awareness Week 2021.