The World Health Organisation (WHO) has warned that the rising levels of resistance to HIV drugs could undermine promising progress against the global fight against the HIV epidemic if effective action is not taken early.

The WHO recently released the HIV drug resistance report 2017 detailing the rise of HIV drug resistance based on national surveys conducted in several countries.

The report showed that in 6 of the 11 countries surveyed in Africa, Asia and Latin America, over 10% of people starting antiretroviral therapy had a strain of HIV that was resistant to some of the most widely used HIV medicines.

Once the threshold of 10% has been reached, the WHO recommends those countries urgently review their HIV treatment programmes.

HIV drug resistance develops when people do not adhere to a prescribed treatment plan, often because they do not have consistent access to quality HIV treatment and care.

Patients with HIV drug resistance will start to fail therapy and may also transmit drug-resistant viruses to others. The level of HIV in their blood will increase, unless they change to a different treatment regimen, which could be more expensive – and, in many countries, still harder to obtain.

“Antimicrobial drug resistance is a growing challenge to global health and sustainable development,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus.

“We need to proactively address the rising levels of resistance to HIV drugs if we are to achieve the global target of ending AIDS by 2030,” continued Dr Ghebreyesus.

Of the 36.7 million people living with HIV worldwide, 19.5 million people were accessing antiretroviral therapy in 2016. The WHO says the majority of these patients are doing well, with treatment proving highly effective in suppressing the HIV virus. However, the organisation warns that increasing HIV drug resistance trends could lead to more infections and deaths.

Mathematical modelling shows an additional 135,000 deaths and 105,000 new infections could follow in the next five years if no action is taken, and HIV treatment costs could increase by an additional $650 million during this time.

“We need to ensure that people who start treatment can stay on effective treatment, to prevent the emergence of HIV drug resistance,” said Director of WHO’s HIV Department and Global Hepatitis Programme, Dr Gottfried Hirnschall.

“When levels of HIV drug resistance become high we recommend that countries shift to an alternative first-line therapy for those who are starting treatment,” continued Dr Hirnschall.

The WHO said it was issuing new guidance for countries on HIV drug resistance to help them act early against it. These included guidelines on how to improve the quality and consistency of treatment programmes and how to transition to new HIV treatments, if and when they are needed.

“This new report shows a worrying picture of increasing levels of HIV drug resistance and, if unchecked, it will be a major risk to programme impact,” said Interim Executive Director of the Global Fund, Dr Marijke Wijnroks.

“We strongly recommend implementing WHO recommendations for early warning indicators and HIV drug resistance surveys in every national plan for antiretroviral therapy, and to consider funding them through Global Fund grants or reprogramming,” concluded Dr Wijnroks.

The WHO HIV drug resistance report 2017 was co-authored by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Centers for Disease Control and Prevention, USA.

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