New Efforts Are Being Made to Fight Drug-resistant HIV

In recent years, major advancements have been made in the fight against HIV, which is evidence of the global health community’s commitment to ending the AIDS epidemic. However, drug-resistant strains of the virus threaten to undo such progress. Fortunately, the World Health Organization (WHO) has responded to this threat with the development of a global action plan.

The AIDS epidemic has claimed the lives of more than 39 million individuals, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). In 2014, UNAIDS announced their 90-90-90 plan for eradicating the AIDS epidemic, outlining a set of goals to achieve by 2020: 90% of all individuals living with HIV will know their HIV status, 90% of all individuals with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all individuals receiving antiretroviral therapy will achieve viral suppression. If these targets are met, at least 73% of all individuals living with HIV worldwide will be virally-suppressed, 2 or 3 times more than those who are currently. Health officials say that meeting these targets will bring the AIDS epidemic to an end by 2030. HIV-related morbidity, mortality, and disease transmission have declined in recent decades, but drug-resistant HIV (HIVDR) — strains of the virus that have mutated to evade treatment with HIV medications – threatens to undo that progress, and thus, prolong the epidemic.

In an article recently published in The Journal of Infectious Diseases, authors from WHO and Tufts University School of Medicine detail The Global Action Plan on HIV Drug Resistance, WHO’s growing effort to respond to HIVDR over the next 5 years. The paper notes that drug-resistant forms of the virus can lead to antiretroviral therapy (ART) failure, a rebound in HIV-associated morbidity and mortality, increasing incidence of HIV, and higher overall treatment costs. Global health officials now consider the emergence and transmission of HIVDR to be a priority in the effort to end AIDS, as individuals who don’t respond to ART are more likely to need a costlier drug regimen or to discontinue treatment entirely. In sub-Saharan Africa, pre-treatment drug resistance is estimated to result in 890,000 deaths, 450,000 new infections, and $6.5 billion in ART program costs over the next 15 years.

WHO’s action plan calls for comprehensive and coordinated action to adopt a 5-part set of objectives aimed at supporting efforts to achieve global targets on health and HIV, and to provide the most effective treatment to all individuals living with the virus, including adults, pregnant and breastfeeding women, children, and adolescents.

“The 5 strategic objectives of the action plan highlight the importance of effective prevention and response to HIVDR and the need to strengthen monitoring and surveillance of HIVDR, invest in innovative research, strengthen laboratory capacity, and establish enabling financial, governance, and advocacy mechanisms to achieve tangible results,” the paper authors write.

In a related paper published in the same journal, researchers from the Johns Hopkins University School of Medicine write that monitoring and genotyping HIV drug resistance with traditional liquid plasma samples poses a challenge in places lacking laboratory infrastructure, trained personnel, reliable electrical sources, and satisfactory transportation systems. The authors argue that the use of a dried blood spot (DBS) technique may be a more optimal approach to the global surveillance of HIVDR, as the filter paper needed to collect samples is easy to obtain and store, minimal training is needed for collection, and specialized equipment and short-term refrigeration is not necessary.

“With the limitations in feasibility and affordability of providing these ideal conditions for plasma genotyping in resource-constrained settings, the field has gained experience with validation, through intense efforts by the World Health Organization, of the DBS technique for HIV-1 drug resistance surveillance,” write the authors, emphasizing the importance of monitoring HIVDR for determining treatment strategies for those who are infected.