[메디컬리포트=Khristian Maclang 기자]
WHO finds HIV drug resistance rising, urges immediate action
Recently, the World Health Organization released its annual HIV drug resistance report with a warning: HIV’s resistance to the most widely used antiretroviral medicines is growing.The news comes as a frightening blow to global HIV advocates and as a reminder that for all the progress which has been made to alleviate the suffering of HIV/AIDS victims the future remains uncertain.
According to WHO’s HIV drug resistance report 2017, “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.” The WHO recommends countries with a resistance rate of 10% or more immediately review their HIV treatment programs to ascertain ways to combat the rise of these stubborn strains of the virus.
WHO Director-General Dr.Tedros Adhanom Ghebreyesus said “antimicrobial drug resistance is a growing challenge to global health and sustainable development,” referring not only to HIV treatment but a host of diseases which can be managed given proper access to medical care and affordable medicines.As consistent access to HIV drugs remains a struggle for many people infected with the virus, most often those living in poverty throughout the global south, drug resistant strains continue to rear their ugly heads.By being exposed to a drug intermittently, diseases such as HIV can develop responses and defenses to what would otherwise effectively hamper their debilitating progress.
According to the WHO, “individuals 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.” Drug resistant HIV can be its own vicious cycle borne and exacerbated by poverty and inaccessible health care.
The report says that HIV drug resistance is caused by “a change (mutation) in the genetic structure of HIV that affects the ability of a particular drug or combination of drugs to block replication of the virus.All current antiretroviral (ARV) drugs, including newer classes, are at risk of becoming partially or fully inactive due to the emergence of drug-resistant virus.” HIV drug resistance can be acquired from the virus itself, part of the strain which infects someone or developed from prior exposure to antiretroviral drugs.Prior exposure to treatment can occur “ for the prevention of mother-to-child transmission of HIV” and can also develop in people “reinitiating first-line ART after a period of treatment interruption without documented virological failure”
19.5 million people HIV infected people had access to antiretroviral therapy last year.That is a majority of the 36.7 million people living with HIV and/or AIDS globally.Most people with access to drug therapy experience few of HIV’s potentially deadly complications as the standard treatment continues to suppress the virus.But now it seems drug resistant strains are on the rise globally.
The 82 page report notes that Uganda (15.4 percent), Namibia (13.8 percent), Zimbabwe (10.9 percent), Nicaragua (19.3 percent), Guatemala (13.2 percent), and Argentina (10.9 percent) are the six nations reaching above the 10 percent threshold for drug resistant strains of HIV set by the WHO.
The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Centers for Disease Control and Prevention, USA co-authored the HIV drug resistance report 2017 alongside the WHO.
In a released statement, the WHO’s Director of WHO’s HIV Department and Global Hepatitis Programme offered the following advice to those countries where drug resistance hits the 10 percent threshold: “shift to an alternative first-line therapy for those who are starting treatment.” Without action such as this, the next five years could see an extra 135 thousand deaths and 105 thousand new infections, deeply troubling figures.
The report argues that “the human cost of HIVDR cannot be underestimated: people with non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance are less likely to achieve viral suppression; more likely to experience virological failure or death; more likely to discontinue treatment; and more likely to acquire new HIVDR mutations”
“This new report shows a worrying picture of increasing levels of HIV drug resistance and, if unchecked, it will be a major risk to program impact,” said Dr.Marijke Wijnroks, Interim Executive Director of the Global Fund.To that end, the WHO announced a new plan to combat HIV drug resistance over the next five years.This Global Action Plan compels countries and partners to join prevention, monitoring, and rapid response efforts while supporting the long term goal of “ending the AIDS epidemic by 2030,” a goal these latest results lower the global likelihood of reaching.Dr.Ghebreyesus believes “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.