Scientists call for increased surveillance as study assessing HIV drug resistance shows rising rates in Africa

July 22, 2012, Lancet

New research published online first in the Lancet suggests that drug-resistant HIV has been increasing in parts of Sub-Saharan Africa since the roll-out of antiretroviral therapy nearly a decade ago.

"Without continued and increased national and international efforts, rising could jeopardize a decade-long trend of decreasing HIV/AIDS-related illness and death in low- and middle-income countries", warn Silvia Bertagnolio from the WHO, Geneva, and Ravindra Gupta at University College London, UK, who led the research. "Nevertheless, estimated levels, although increasing, are not unexpected in view of the large expansion of antiretroviral seen in low-income and middle-income countries. In 2011, about 8 million people in these countries received ART, a figure 26 times greater than the number in 2003."

This is the first study to systematically assess the prevalence of HIV in low-income and middle-income countries, where over 90% of people with HIV live and 97% of new infections worldwide are to be found.

After searching systematically for studies over the past 10 years containing data on HIV drug resistance in untreated adults, and using data from the WHO HIV drug resistance surveillance programme, the researchers identified 162 reports and 27 unpublished including over 26 000 individuals (aged 15 years or older) from , Asia, and Latin America. They estimated levels and changes in the prevalence of HIV-1 drug resistance since the scale-up of ART.

Overall, their findings suggest a significant increase in prevalence of drug resistance over time since antiretroviral roll-out in regions of sub Saharan Africa. This rise is mainly driven by non-nucleoside reverse transcriptase inhibitors (NNRTI) resistance in East and .

The most rapid increase in drug resistance occurred in , at 29% per year, reaching an overall prevalence of 7.4% 8 years after rollout. This was considerably higher than the estimated 14% rise in Southern Africa, where the prevalence of drug resistance reached 3% 6 years after roll out. Rates of resistance for NNRTIs were slightly higher, rising by 36% per year in East Africa and 23% per year in Southern Africa.

Gupta and colleagues noted no change in resistance over time in Latin America and in West and Central Africa, while the heterogeneity between countries in Asia made it impossible for them to assess time trends in this region.

According to the authors, "In view of these findings, urgent action is clearly needed to maximise the long-term effectiveness of available first-line regimens and to enhance population-level resistance surveillance and prevention efforts in national HIV treatment programmes. [This should include] the establishment of robust supply chains to prevent drug stock-outs and treatment interruptions and early identification of individuals failing therapy."

In a linked Comment, Douglas D Richman from the University of California San Diego in the USA says, "Many of these missing resources and capabilities are components of the WHO/UNAIDS Treatment 2.0 goals, which if achieved could avert an additional 10 million deaths by 2025."

Explore further: HIV drug resistance creeps higher: WHO

More information: www.thelancet.com/journals/lan … (12)61038-1/abstract

Related Stories

HIV drug resistance creeps higher: WHO

July 18, 2012
Drug resistance to HIV medicines has been creeping higher in parts of Africa and Asia but is not steep enough to cause alarm, said a survey released by the World Health Organization on Wednesday.

Facts about HIV/AIDS worldwide in 2011

July 18, 2012
Here are some key facts and figures on HIV/AIDS in 2011, released by UNAIDS on Wednesday ahead of the International AIDS Conference set to take place in Washington on July 22-27.

Study finds early signs of malaria drug resistance in Africa

April 27, 2012
Africa's deadliest malaria parasite has shown resistance in lab tests to one of the most powerful drugs on the market -- a warning of possible resistance to follow in patients, scientists said Friday.

Recommended for you

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Researchers offer new model for uncovering true HIV mortality rates in Zambia

January 12, 2018
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

New drug capsule may allow weekly HIV treatment

January 9, 2018
Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule ...

New long-acting, less-toxic HIV drug suppresses virus in humanized mice

January 8, 2018
A team of Yale researchers tested a new chemical compound that suppresses HIV, protects immune cells, and remains effective for weeks with a single dose. In animal experiments, the compound proved to be a promising new candidate ...

Usage remains low for pill that can prevent HIV infection

January 8, 2018
From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which—in their view—remains woefully ...

Researchers find clues to AIDS resistance in sooty mangabey genome

January 3, 2018
Peaceful co-existence, rather than war: that's how sooty mangabeys, a monkey species found in West Africa, handle infection by SIV, a relative of HIV, and avoid developing AIDS-like disease.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.