Political strife undermines HIV treatment
Highly active antiretroviral therapy (HAART) is difficult to maintain under the best of circumstances. War, civil conflict, and political strife displace hundreds of thousands of people, devastating therapy and allowing HIV to increase its resistance to antiviral drugs. Here displaced Kenyan's live in tents in April 2008. Credit: Rami Kantor/Brown University
As Kenyan citizens negotiated the tensions following the March 4 nationwide elections, memories of the violence that followed the December 2007 vote weighed heavily for many reasons. Among those in any nation with an HIV epidemic, argue authors of a new paper in AIDS Reviews, should be the long-term damage that political conflict can do to public health by disrupting treatment and thereby promoting resistance to antiretroviral drugs and treatment failure.
"It's the long-term consequences that make this a bigger issue," said lead author Marita Mann, who began studying the rise of drug resistant HIV in the wake of Kenya's 2007 strife when she was a Brown University Master of Public Health student. She is now a doctoral student at the University of Washington. "First there are the patients who are affected themselves during the conflict and may be resistant to treatment later on, but this also may lead to transmitted resistance that will be a bigger problem in the epidemic."
This time around in advance of the elections, Mann said, some Kenya health workers gave their patients extra supplies of medicine and papers that would help them transfer to another clinic in case they were displaced by new violence. In 2007, more than 1,000 Kenyans died and about 300,000 were displaced.
But many policymakers and health officials in HIV- and strife-ridden nations have not recognized the link between disrupted treatment and the potential for increased treatment failure and viral resistance, said senior author Dr. Rami Kantor, associate professor of medicine at Brown University and an infectious diseases physician at The Miriam Hospital in Providence.
The paper seeks to make that link clear by explaining how an unplanned treatment interruption can lead to increased viral drug resistance and treatment failure and by describing the research needed to mitigate the effects of treatment interruption in future conflicts.
The paper provides an overview, but the underlying concern is neither prospective nor hypothetical. In data they have presented at an international HIV conference but not yet published, Mann, Kantor, and colleagues from the AMPATH academic medical collaboration in Kenya found that after the 2007 violence, treatment in subjects whose drug regimens were interrupted by the conflict failed significantly more often than treatment in subjects who did not suffer a conflict-related disruption.
How conflict breeds resistance
HIV mutates often and research shows that as little as a single amino acid change can lead to drug resistance, the authors write. Modern "highly active" antiretroviral therapy (HAART) fights HIV with a potent mix of several drugs that attack the virus in multiple ways, successfully suppressing its replication in most patients.
When violence erupts, staying on those delicately balanced medications can become impossible. Drugs may no longer get to the clinic, patients and health care workers can become displaced, travel to the clinic can become unsafe, and patients can become profoundly depressed by the horror and tragedy around them.
After an unplanned treatment interruption takes place, the multipronged attack of HAART falls apart in an insidious fashion. Some drugs stay in the patient's system longer than others, leaving only a partial therapy in place. That partial therapy fails to stop the virus, instead encouraging the evolution of resistant strains. When full HAART resumes, the virus is better prepared to resist it.
Different variants of the virus will show differences in their likelihood of evolving resistance after an unplanned treatment interruption, the researchers predict.
What can be done
Mann said the steps her colleagues in Kenya took in advance of this year's elections—providing extra medicine and clinic transfer papers—were good ones to take at the level of an individual clinic, assuming they have extra doses of medicine on hand.
Similarly, Kantor said, "In the 2007 conflict AMPATH did a great job to do as much as possible to address the potential issues that we're raising and made great efforts to reach patients to resume care as soon they could, despite the post-conflict displacement and chaos. AMPATH has undertaken similar efforts and preparations for this month's Kenyan elections, including managing treatment stocks, on-call staff, logistical support, and participating in regional and national coordination."
But in the paper, the authors point out that neither health care providers nor officials have much of a rigorous knowledge base to refer to in managing unplanned treatment interruptions. And many officials do not consider or plan for the problem at all.
To better inform and prepare providers and officials, not only in Kenya but in other strife-prone nations with high rates of HIV infection, authors call for further research and attention to planning.
"Research is therefore needed to determine optimal ART stopping and restarting strategies for patients who find themselves in situations of unplanned interruptions," the authors write. "An additional strategy should encompass implementation of contingency treatment plans in developing countries addressing factors like consistent drug supplies, improved patient follow-up, education for healthcare providers, implementation of viral load monitoring and resistance testing and availability of multiple treatment regimens."
And if political leaders and their opponents happen to need one more reason to forgo violence, they can consider how it appears to worsen the HIV pandemic among their constituents.
Journal reference: AIDS Reviews
Provided by Brown University
- HIV drug resistance creeps higher: WHO Jul 18, 2012 | not rated yet | 0
- Sensitive testing reveals drug-resistant HIV with possible consequences for treatment Jul 29, 2008 | not rated yet | 0
- Researchers develop new method for screening drug-resistant forms of HIV Jun 28, 2007 | not rated yet | 0
- Treatment outcomes of patients with HIV and tuberculosis Jun 01, 2007 | not rated yet | 0
- Researchers find that pre-existing mutations can lead to drug resistance in HIV virus Jun 07, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...
HIV & AIDS 5 hours ago | 5 / 5 (3) | 0 |
Detection of HIV antibodies is used to diagnose HIV infection and monitor trials of experimental HIV/AIDS vaccines. New, more sensitive detection systems being developed use microspheres to capture HIV antibodies ...
HIV & AIDS 21 hours ago | 5 / 5 (1) | 0
(HealthDay)—For HIV-infected individuals with recurrent Clostridium difficile infection, fecal microbiota therapy is feasible, according to a letter published in the May 21 issue of the Annals of Intern ...
HIV & AIDS May 22, 2013 | not rated yet | 0
Canadian health authorities lifted Wednesday what was effectively a ban on gay men giving blood, announcing new rules making men who have not had sex with men in the past five years eligible.
HIV & AIDS May 22, 2013 | not rated yet | 1
Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...
17 minutes ago | not rated yet | 0 |
Kate O'Reilly's spring allergy survival kit includes the usual stuff - nasal sprays, allergy pills and a box of tissues. This season, she's added a new weapon to her line of defense: an app on her smartphone.
58 minutes ago | not rated yet | 0
(AP)—Government health officials are investigating several health problems reported with potentially contaminated medications made by a Tennessee specialty pharmacy.
11 minutes ago | not rated yet | 0
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
2 hours ago | not rated yet | 0 |
Biological processes are generally based on events at the molecular and cellular level. To understand what happens in the course of infections, diseases or normal bodily functions, scientists would need to ...
3 hours ago | 5 / 5 (2) | 0 |