WHO recommends routine surveillance of HIVDR to track prevalence & patterns of resistance, critical for shaping treatment guidelines and improving programme quality
Resistance to the antiretroviral drug dolutegravir (DTG) is increasing among HIV patients, a new report by the World Health Organization (WHO) highlighted.
Since 2018, WHO has recommended dolutegravir as the preferred first- and second-line HIV treatment due to its effectiveness, ease of use and minimal side effects. However, survey data from four sources indicate resistance levels ranging from 3.9-8.6 per cent, reaching 19.6 per cent among individuals with high viral loads who transitioned to DTG-containing antiretroviral therapy (ART).
“The worrying evidence of resistance in individuals with unsuppressed viral load despite dolutegravir treatment underscores the necessity for increased vigilance and intensified efforts to optimize the quality of HIV care delivery,” said Dr Meg Doherty, director of the WHO department of the Global HIV, Hepatitis and STI Programmes.
The HIV Drug Resistance (HIVDR) Report also revealed a positive development: High levels of HIV viral load suppression (>90 per cent) in populations receiving DTG.
Haiti reported a unique case where an infant, born to a mother receiving DTG-based ART, showed resistance to DTG. This highlights the importance of managing high viral loads in pregnant and breastfeeding women to prevent HIV transmission to infants.
Despite progress, the global response to HIV faces challenges. The report revealed that the Sustainable Development Goal (SDG) targets are off track, with 1.3 million new HIV infections and 630,000 HIV-related deaths reported in 2022.
Several countries failed to meet established global targets for HIV treatment indicators, emphasising the need for improved quality of treatment and care services.
Furthermore, only 12 of 45 WHO focus countries conducted surveys or integrated HIV drug resistance early warning indicators into routine monitoring systems in 2022, the analysis pointed out. Issues such as suboptimal retention in care, viral load suppression and antiretroviral drug stock-outs persist, negatively impacting patient adherence.
The authors of the report recommended routine surveillance of HIVDR to track prevalence and patterns of resistance, critical for shaping treatment guidelines and improving programme quality.
Additionally, it highlighted instances of resistance to integrase-strand transfer inhibitors (INSTI) after exposure to cabotegravir (CAB-LA), emphasising the importance of timely HIV detection.
Despite the risks, the WHO supported the rollout of CAB-LA for pre-exposure prophylaxis (PrEP), calling for standardised surveillance of drug resistance among individuals testing positive for HIV while on PrEP.
Routine monitoring of quality-of-care indicators, including on-time ART pick-up and viral load testing coverage, are crucial for successful ART programmes.
The report underscored the need for strengthened data reporting systems to monitor and report quality-of-care indicators effectively. It emphasises the active engagement of ART clinics and programmes in utilising indicator data to develop sustainable solutions, crucial for optimising service delivery quality and reducing the emergence of drug-resistant HIV.
The global response to minimise the spread of HIV drug resistance requires coordinated action across all government sectors and society levels.
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