WHO calls for vigilance to tackle rising drug resistance

Thursday August 3 2017

ARV drugs. According to the health agency, the

ARV drugs. According to the health agency, the increasing HIV drug resistance could lead to more infections and deaths and outdo the ongoing progress towards ending the Aids epidemic by 2030. PHOTO FILE | NATION 

By ELIZABETH MERAB
More by this Author

The World Health Organisation has asked countries to monitor the quality of their HIV treatment programmes, amid rising cases of drug resistance.

According to the health agency, the increasing HIV drug resistance could lead to more infections and deaths and outdo the ongoing progress towards ending the Aids epidemic by 2030.

WHO notes that in six of 11 countries surveyed for drug resistance in Africa, Asia and Latin America, over 10 per cent of people starting antiretroviral therapy (ART) had a strain of HIV that was resistant to common drugs.

“We need to ensure that people who start treatment can stay on effective treatment to prevent the emergence of HIV drug resistance,” said Dr Gottfried Hirnschall, director of WHO’s HIV department and global hepatitis programme.

“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.”

Statistics suggest an additional 135,000 deaths and 105,000 new infections could follow in the next five years if no action is taken, while HIV treatment costs could increase by an additional $650 million.

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

In severe cases, the patient will require to move to either the second or third-line treatment regimens, which are three times and 18 times more expensive, respectively, than first-line drugs, says the WHO.

In Kenya, the findings of a study show that at least one in 10 HIV-positive people in Homa Bay County in the west of the country has a strain that is resistant to at least one of the available antiretroviral drugs, even when he or she has never been put on any treatment.

Homa Bay County has the highest HIV prevalence rate in Kenya at 26 per cent, with at least 400 children getting infected every day.

Currently, it costs the Kenyan government Ksh20,000 ($200) annually to put one HIV patient on treatment.

There are over 1.6 million Kenyans living with the virus and about one million on treatment. Of these, it is not clear how many have transmitted drug resistant HIV (TDR).

National resistance rates per region, which range between one and 13 per cent over the past decade, however suggest that there could be 4.5 per cent in the capital Nairobi, and 1.1 per cent and 13.2 per cent in Kilifi and Mombasa respectively on the Coast.

“Our results show that the transmitted drug resistant level in rural western Kenya is relatively higher than for most regions. We suggest that the survey be repeated in order to confirm these findings, to further understand the scale of the problem and the potential sources of HIV drug resistance,” said Mr Onywera, who spoke to the Nation Media Group when the study was published this year.

To address the problem, the Kenyan government has launched a generic version of the most advanced drug for the virus called Dolutegravir (DTG), becoming the first African country to include it in its treatment programmes.

In Tanzania, a study published early this year in the journal AIDS called for the urgent monitoring of viral load among HIV-positive children in order to maintain future treatment options.

The study showed that the virologic failure rates in children and adolescents were high, with the majority of ART-failing children harbouring HIV drug resistance-associated mutations. Virologic failure occurs when antiretroviral therapy fails to suppress and sustain a person’s viral load to “safe” levels.

The Tanzanian government has also announced plans to include DTG in its national HIV/Aids treatment protocols.

The Minister of Health, Community Development, Gender, Elderly and Children, Ummy Mwalimu, early this month told The Citizen that the drug had been lined up for registration and licensing by the Tanzania Food and Drugs Authority.

“Shipments are scheduled to start in January 2018 after the Authority’s registration process is completed,’’ Ms Mwalimu told The Citizen.

DTG, which was first approved in the US in 2013, will also be rolled out in Nigeria and Uganda later this year.