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Africa is facing a growing HIV drug resistance that could reverse the significant progress made so far in the fight against the virus on the continent, the World Health Organization (WHO) says.
 
The WHO and partners have developed a five-year (2019-2023) regional plan to monitor, prevent and respond to HIV drug resistance in Africa.
 
Studies conducted in 49 countries between 2004 and 2019 show that HIV drug resistance is on the rise globally. However, Africa could be the hardest hit because it has 70 per cent of the world’s people living with HIV and 66 per cent of all new infections, says the WHO.

“HIV drug resistance leads to an increase in hard-to-treat infections, deaths, increasing the cost needed to treat patients and allowing the spread of the virus,” explains Fatim Cham-Jallow, technical officer in charge of the communicable diseases cluster at the WHO Regional Office for Africa.

“The consequences of HIV drug resistance include treatment failure and further spread of drug-resistant HIV.”

Fatim Cham-Jallow, WHO Regional Office for Africa

The Regional Action Plan unveiled at the International Conference on AIDS last week (6 December) in Rwanda is a framework for monitoring HIV drug resistance indicators, and how these indicators could be used at clinic and programme levels to minimise drug resistance and develop evidence-based quality improvement for antiretroviral medicine programmes.

Cham-Jallow tells SciDev.Net that the ability of HIV to multiply itself in the presence of antiretroviral drugs is a critical health threat.

“The consequences of HIV drug resistance include treatment failure and further spread of drug-resistant HIV,” Cham-Jallow says. “Currently, 16.4 million people living with HIV are on treatment in the African region and increased access to anti-retroviral drugs has resulted in several gains in reducing HIV mortality and new infections.”

Data from the 2019 HIV drug resistance report shows that resistance to the previously most commonly used first line drugs efavirenz and nevirapine is becoming a big problem, especially among patients initiating treatment.

Another study showed that resistance in patients starting treatment was increasing every year and had exceeded the levels of 10 per cent in Eastern and Southern Africa by 2016.

Cham-Jallow says that HIV drug resistance is a threat to public health in Africa especially because of weaker health infrastructures when compared to Europe, North America and Asia, adding that women are particularly at risk.  

Citing a modelling study, Cham-Jallow tells SciDev.Net that failure to act on the current levels of HIV drug resistance in adults could lead to 450,000 new HIV infections, 890,000 deaths and US$6.5 billion more treatment costs over the next 15 years in Sub-Saharan Africa.

The Regional Action Plan aims to support member states in implementing actions to effectively mitigate, monitor and respond to the threats of HIV drug resistance. Halima Dawood, an honorary senior scientist at the Centre for the AIDS Programme of Research in South Africa, says that the problem of HIV drug resistance is growing but not unexpected as these drugs have been used for more than ten years.

Dawood says that the WHO move is great but “it will depend on resources available...drug resistance testing is currently very expensive and health systems [are] already overburdened by HIV treatment programmes”.

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.


References

  1. WHO HIV drug resistance report 2019 (July 2019)
  2. Gupta and others HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis (November 30, 2017)

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