By: Ed Susman
WASHINGTON, DC – Resistant virus is appearing at substantial rates as treatment for HIV infections increases in Africa, researchers reported at the 19th International AIDS Conference.
Binta Sultan, MBBS, University College London, London, United Kingdom, reported on outcomes from a meta-analysis of studies conducted between 2001 and 2011 at a late-breaker poster presentation. The meta-analysis involved 26,102 patients in Africa, Asia, and Latin America.
Dr. Sultan and colleagues reported a 29% increase in HIV resistance to antiretrovirals in East Africa, an increase of 14% in southern Africa and a nonsignificant 3% increase in West Africa. “Our findings suggest a significant increase in prevalence of drug resistance over time, since the antiretroviral rollout in regions of sub-Saharan Africa,” they wrote. “This rise is driven by non-nucleoside reverse transcriptase inhibitor resistance in studies from east and southern Africa.”
“The findings are of concern and draw attention to the need for enhanced surveillance and drug-resistance prevention efforts by national HIV treatment programs,” they reported.
The team noted, however, that the increases in resistance were expected — considering that there were no previous treatments, and subsequently little resistance would have been seen prior to the rollout that now reaches 8 million people. While advocating surveillance, the authors did not believe that guideline revisions were necessary.
The resistance, which was mainly seen in non-nucleosides, was most likely due to use of those drugs in limited doses and in monotherapy to prevent mother-to-child HIV transmission.
The researchers conducted a literature review, identifying 66 studies detailing treatments among cohorts in Africa, Asia, and Latin America. The heterogeneity of the 16 Asian studies prevented regional analyses, Dr. Sultan explained. The team scrutinised 48 studies undertaken in Africa and 2 in Latin America. There was no change in resistance in Latin America.
Limited national infrastructure, a shortage of healthcare professionals, inconsistent supply chains and weak enforcement of quality standards may all be contributing to drug resistance, Sultan hypothesised.
- MFP Wire Services