International Aids Society president Linda-Gail Bekker (left) and
President of the French National Ethics Advisory Committee and
conference chairman Jean-Francois Delfraissy. PHOTO | AFP
Summary
- Experts say there is a big risk in treating and preventing the condition if early and effective action is not taken.
- WHO has developed new tools to help countries to monitor HIV drug resistance, improve the quality of treatment programmes and transition to new HIV treatments, if needed.
- The dose is one pill daily for seven days and is meant to build adequate protection before exposure to risk of infection.
- Many Kenyans are still reluctant to go for test because of the spectre of stigmatisation.
Resistance to drugs used for treating
HIV/Aids has increasingly come under the spotlight given the impact
this could have on the progress made in managing the disease.
Experts say there is a big risk in treating and preventing the condition if early and effective action is not taken.
The World Health Organisation (WHO) has called on countries to urgently review their treatment programmes.
Detailed
findings in The WHO HIV drug resistance report 2017, based on a
national research conducted in several countries, reveal that in six of
the 11 countries surveyed in Africa, Asia and Latin America, over 10 per
cent of people starting antiretroviral therapy have a strain of HIV
that is resistant to some of the most widely used HIV medicines.
The
WHO recommends that once the threshold of 10 per cent has been reached,
the countries should review their HIV treatment programmes immediately.
“Antimicrobial
drug resistance is a growing challenge to global health and sustainable
development,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus.
“We need to proactively address the rising levels of
resistance to HIV drugs if we are to achieve the global target of ending
Aids by 2030.”
Drug resistance develops when people do
not adhere to a prescribed treatment plan, often because they do not
have consistent access to quality HIV treatment and care.
Individuals
with HIV drug resistance will start to be unresponsive to therapy and
may also transmit drug-resistant viruses to others. The level of HIV in
their blood will increase unless they change to a different treatment
regimen, which could be more expensive and in many countries, still
harder to obtain.
Of the 36.7 million people living with HIV worldwide, 19.5 million people were accessing antiretroviral therapy in 2016.
The
majority of these people are doing well, with treatment proving highly
effective in suppressing the HIV virus. But a growing number are
experiencing the consequences of drug resistance.
In
addition to the report, guidelines and the global action plan on HIV
drug resistance that countries should adhere to, the WHO released seven
new key guidelines and tools at the 9th International Aids Society
Conference on HIV Science in Paris, France last week.
The
set of guidelines include a new information note on point-of-care early
infant diagnosis ASSAYS (investigative procedure in laboratory,
pharmacology) to support timely detection of HIV in children.
It
also requires that countries monitor the quality of their treatment
programmes and take action as soon as treatment failure is detected.
Countries
are also encouraged to prioritise research for children and adolescents
to address low treatment and quality care for this group.
New
guidelines on advanced HIV infection and rapid initiation of
antiretroviral recommends screening, treatment and prophylaxis for major
opportunistic infections (such as tuberculosis), and rapid initiation
of ART and adherence support for people with advanced HIV.
A
new technical update advises countries on what to consider when
transitioning to a new treatment regimen, including dolutegravir.
The
new report also outlines how countries can provide differentiated,
carefully-tailored services for various needs of patients.
The ninth International Aids Society conference on HIV Science last week, in Paris. PHOTO | AFP
The ninth International Aids Society conference on HIV Science last week, in Paris. PHOTO | AFP
“We need to ensure that people who
start treatment can stay on effective treatment to prevent the ...
emergence of HIV drug resistance,” said Dr Gottfried Hirnschall, Director of WHO’s HIV Department and Global Hepatitis Program.
emergence of HIV drug resistance,” said Dr Gottfried Hirnschall, Director of WHO’s HIV Department and Global Hepatitis Program.
“When
levels of HIV drug resistance become high we recommend that countries
shift to an alternative first-line therapy for those who are starting
treatment.”
Speaking at the conference, Dr Hirnschall
said increasing HIV drug resistance trends could lead to more infections
and even cause deaths.
“We are worried that if nothing
is done by the countries, we will lose over 135,000 people and record
over 105,000 new infections in the next five years,’’ he said.
Professor Linda Gail Bekker, International Aids Society President,
said HIV resistance is a big issue because donor funding for the
programme is declining.
She said countries need to move
with speed and concentrate on the basic science and research, which are
critical in the formulation of new regimens.
Prof Bekker said more new drugs are needed to fight the drug resistance.
She added that tackling HIV drug resistance will require the active involvement of a broad range of partners.
Currently,
there is a new five-year Global Action Plan which calls on all
countries and partners to join efforts to prevent, monitor and respond
to HIV drug resistance and to protect the ongoing progress towards the
sustainable development goal of ending the Aids epidemic by 2030.
In
addition, WHO has developed new tools to help countries to monitor HIV
drug resistance, improve the quality of treatment programmes and
transition to new HIV treatments, if needed.
“This new
report shows a worrying picture of increasing levels of HIV drug
resistance and, if unchecked, it will be a major risk to programme
impact,” said Dr Marijke Wijnroks, Interim Executive Director of the
Global Fund.
“We strongly recommend implementing WHO
recommendations for early warning indicators and HIV drug resistance
surveys in every national plan for antiretroviral therapy, and to
consider funding them through Global Fund grants,” said Dr Wijnroks.
Countries
must work on the recommendations to be safe, said Dr Shannon Hader,
Director of Centre of Disease Control’s Division of Global HIV and
Tuberculosis at the US Centers for Disease Control and Prevention.
“The
new report pulls together key HIV drug resistance survey findings from
across the globe that, taken together with other national-level data,
confirm we must be forward-thinking in our efforts to combat resistance:
scaling up viral load testing, improving the quality of treatment
programmes, and transitioning to new drugs like dolutegravir,” she said
alongside other speakers during the conference.
Kenya has been introducing new products to boost the fight against HIV/Aids and curb the growing rate of resistance.
Currently,
about 1.5 million HIV patients receive ARVs from the government for
free, costing the taxpayer an average of Sh20,000 yearly per person.
Recently,
the country introduced a generic version of the most advanced drug for
the virus. Dolutegravir, manufactured by the Indian pharmaceutical
Aurobindo Pharma, will be available free of charge in public hospitals
and select private facilities.
Kenya is the first
country in Africa to roll out the generic version of the drug and the
second after Botswana to launch the drug for routine use. This,
researchers say, is a move in the right direction.
The
medicine is used as a first-line treatment among patients taking
anti-retroviral drugs. It is a small tablet taken daily with two other
drugs as it is a combination therapy.
The drug which
was in the past two years accessible to patients in the high income
countries as the drug of choice because of its cost, will now be
available to all in the country.
Researchers have
recommended the drug for patients who are resistant to second-line ARVs
as well as HIV-positive people who inject drugs.
This
is one of the drugs that were recommended by the WHO in 2015 as an
alternative first-line treatment for adults and adolescents.
“We
want to make HIV drugs accessible to all so that whenever you are
tested positive, you are placed on the drugs immediately. We want to
give them quality and affordable treatment,’’ said Dr Nduku Kilonzo,
National Aids Control Council Director.
Dr Kilonzo
noted that when treatment is available and people adhere to the right
treatment, cases of high HIV resistance will be reduced.
“With the introduction of new products, I must say that we are headed somewhere ...,’’ she said.
Prof Bekker praised Kenya for doing great to fight the scourge but added that a lot more is expected of the country.
“With
the introduction of the drug, we are hopeful that more people are going
to get the drug and that the resistance will be something to deal with
since they will have consistent access to quality HIV treatment and
care,’’ she said.
In March, Kenya rolled out a new drug meant to protect HIV-negative people from contracting the virus.
The
drug, known as Pre-exposure Prophylaxis (PrEP) and which can prevent
HIV infection by more than 96 per cent, is currently given to those at
high risk of contracting the virus before being made accessible to the
rest of the population.
The dose is one pill daily for seven days and is meant to build adequate protection before exposure to risk of infection.
“We
are simply taking care of the uninfected lot to avoid more infections,”
said Dr Kilonzo adding that Kenya has been recording high HIV
infections.
The drug has been included in the current HIV prevention methods as the most recent strategic framework.
Dr
Hader said overall high rates of viral suppression across three recent
national Population-based HIV Impact Assessments showed that present
first-line regimens remain largely effective.
However,
she said special attention to populations at risk for higher
resistance, such as paediatrics, adolescents, pregnant women and key
populations, will be critical. “We call on the global community for
continued vigilance and responsiveness,” she said.
The
results of “STAR-self-testing in Africa” an implementation research
effort, together with a new landscape report on rapid diagnostic tests
for HIV self-testing, is a plus to many countries. This has also been
introduced in Kenya for people who want to know their HIV status in the
privacy of their homes, offices or even at community clinics. It is
considered a big milestone in the fight against the virus.
The
kits will be available in private pharmacies and would cost Sh800 to
Sh1,000. Test will be done through oral swab and a blood sample.
The
oral kit, known as OraQuick, will require the user to do a 360 swab of
the upper and lower gum of the mouth before placing the swab in a
reagent, which will give results in 20 minutes.
Those
using the blood sample kit known as INSTI, would be required to prick a
finger and put the blood in a control kit to read the results. Unlike
the oral test, the blood sample test gives the results instantly.
If
the test is non-reactive or negative self-test, the user is advised to
also seek services that will link them to HIV prevention services such
as condoms and male circumcision.
Many Kenyans are still reluctant to go for test because of the spectre of stigmatisation.
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