How Drug Resistance Could Affect the Prevalence of HIV/AIDS

More than 1.1 million people in the country are living with HIV and more than 18,000 people were diagnosed with AIDS in 2015, according to the most recently available data.

Thirty years ago, HIV and AIDs were deadly diseases that killed thousands of Americans during the height of the epidemic, but treatment advancements have helped more people live longer.

However, New England Journal of Medicine indicates a worrying trend that could affect the gains we’ve made in treating and helping people manage this disease: HIV resistance to antiretroviral (ART) medications is increasing.

Rising HIV Resistance

An estimated 19.5 million people globally are living with HIV and receiving ART medications. Officials for the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) say that HIV drug resistance has increased to 29 percent today, up from 11 percent just 16 years ago when ART was first rolled out.

HIV drug resistance occurs when the virus mutates and replicates itself when someone is on ART drugs, making these medications less effective and leading to treatment failure. When someone has HIV and their medications don’t work effectively, this could potentially enable the virus to develop into AIDS, which is the final and deadliest stage of HIV infection.

HIV drug resistance may be increasing for several reasons. People not taking their ART medications consistently or in the correct dosage is a significant issue, but researchers say program failures, drugs being out of stock and long wait times at clinics and drug dispensaries may contribute to this, as well, and may even affect patients who are adhering to their regimen. Despite challenges with treatment access, lack of adherence may be the biggest issue because not sticking to an ART regimen can make it more likely that HIV drug resistance occurs, which in turn increases the risk the virus will progress to AIDS.

Researchers say the medical community needs to place more emphasis on prevention and work more quickly to develop a vaccine for the virus. They also suggest increasing the use of Truvada for PrEP, or preexposure prophylaxis, a medication that  can reduce HIV risk and has to be taken every day. Daily PrEP can reduce HIV risk by as much as 90 percent, the CDC says.

The researchers who conducted the review also say health officials should rapidly rollout newer regimens with higher genetic barriers to resistance to people already infected with HIV. These drugs could include integrase inhibitor dolutegravir, which has a really high resistance barrier. There only has been one reported case of resistance when this medication is used as the initial treatment.

Researchers say the emergence of HIV drug resistance warrants greater efforts and greater investment to sustain global treatment initiatives and programs. Because of globalization, the world is increasingly smaller, so public health epidemics in one country may eventually affect others. HIV and AIDs are no different. For more than 30 years, we’ve seen how this disease has ravaged people’s spirits and taken lives. New medication regimens have helped us to increase survival  rates, but this disease is still a scourge and has led to thousands of deaths in the U.S. every year and millions more globally. We have to do something to maintain the progress we’ve made, and refocusing our efforts on HIV drug resistance may be the most effective way to accomplish this and to save even more lives in the future.