Rates of transmitted HIV drug resistance in low- and middle-income countries most affected by HIV have only increased modestly, according to recently published research in PloS Medicine.
The findings describe a low increase in sub-Saharan Africa and no increase in the prevalence of transmitted HIV drug resistance in South Asia and Southeast Asia. In fact, overall drug resistance prevalence varies widely, with a prevalence of 2.8% in sub-Saharan Africa compared to a much higher prevalence of 11.5% in North America.
Researchers from Stanford University School of Medicine analysed data from more than 50,000 people living with HIV in 107 different countries to measure the current global extent of HIV drug resistance. The researchers scanned the data for the presence of 93 mutations that have previously shown to be indicative of HIV drug resistance.
Antiretroviral treatment (ARV) treatment failure occurs in 10% to 30% of the people living with HIV each year, and will persist as long as people living with HIV are not put on more robust and less vulnerable treatment regimens. Ongoing monitoring is needed as it is predicted that drug resistance will increase, which has the potential to negatively affect the gains made by different development organisations promoting access to antiretroviral treatment.
Most transmitted drug resistant strains of HIV detected in sub-Saharan Africa and South/Southeast Asia arose independently. This suggests that improved adherence to antiretroviral treatment, alongside using the most effective drug regimes, should reduce the establishment of new drugs resistant strands and mitigate the transmission of drug resistant HIV. Researchers therefore suggest the development of a test to identify key resistance-related mutations. This resistance test could be used in conjunction with a viral load test, and will give care providers an idea if treatment needs to be changed and if adherence counselling is needed. This way, the use of drugs regimes that are vulnerable to drug resistance could be phased out.