Researchers detect drug-resistant HIV 

A health worker analyses blood samples collected from people living with HIV/Aids A study has detected drug resistant HIV among 66 percent of infected persons in first-line treatment, who were grappling with poor viral load suppression. Photo/File

What you need to know:

  • At least 840 people living with HIV in Uganda and South Africa participated in the study.

A study conducted in Uganda and South Africa has detected drug resistant HIV among 66 percent of infected persons in first-line treatment, who were grappling with poor viral load suppression. 
The revelation was made during the International Conference on HIV Treatment, Pathogenesis, and Prevention Research in Resource-Limited Settings (INTEREST) 2022 in Kampala on Tuesday.
The conference began on Tuesday and will end tomorrow.

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HIV drug resistance is caused by changes in the genetic material of HIV that affects the ability of medicines to stop them from multiplying, and lack of adherence to treatment, according to the researchers.
Speaking to Daily Monitor during the event, Mr Jonan Tumwesigyire, a scientist in the research team, said the study was done in Mbarara District and Durban, South Africa on 840 patients whom first-line treatment had failed. 
Mr Tumwesigyire said the patients were randomly divided into two groups – standard of care arm (SCA) and resistance testing arm (RTA).
He added that of the 417 who were tested for resistance, 275 turned out positive. 

“If someone has a high viral load above 1,000 copies per milliliter, and you do the test and find that they are negative for resistance, it means that person is not taking their drugs. That is an adherence issue,” he said.
“The resistance detected among those tested is similar to other studies done in other areas. That is why there is a need to move away from Nevirapine and efavirenz as first line drugs to the new drug, Dolutegravir-based regimen,” he added.  
Government, with support from development partners, is providing free medication for more than 1.1 million persons living with HIV (PLHIV) who are enrolled in treatment. There are around 1.4 million PLHIV, according to the UAC. 

A total of 94 percent of these are on first-line therapy, 5.5 percent are on second-line therapy, and a small proportion 0.1 percent are on third-line regimen, according to the Ministry of Health statistics. 
The resistance means the government will be spending more to treat PLHIV and these will also be at higher risk of dying because of limited supply of the third line drugs. 
First line treatment drugs in Uganda, according to the Ministry of Health, include drugs like Tenofovir disoproxil fumarate (TDF), Lamivudine and Dolutegravir (DTG). 
Second line drugs in Uganda include lopinavir or atazanavir, and and a recycled nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) which include Abacavir, Emtricitabine and Lamivudine.
 
Third line drugs in Uganda include ritonavir-boosted darunavir (DRV/r), raltegravir, and etravirin.
The researchers said: “Interventions that improve management of virological failure are urgently needed to maintain control of the global HIV epidemic.”
The director general of UAC, Dr Nelson Musoba, said the injectable Antiretroviral therapy (ART) will address the problem of stigma associated with daily oral pills and this he said will improve treatment adherence, thus minimising drug resistance.
 
Dr Andrew Kambugu, the director of Infectious Diseases Institute (IDI) of Makerere University, said they expect to complete the demonstration of the injectable ART in 12 months and roll it out to the wider public next year. 
“Currently people swallow tablets daily but we now know that you can get an injection every two months. Those treatments are here. They are under demonstration for us to see how they work in Africa,” he said.

“The injectable ART is being tested at the Joint Clinical Research Centre and the IDI are some of the places where we are rolling out the injectable drug called Cabotegravir. We hope that we will be able to show that you can use this treatment in this setting. As someone who sees persons living with HIV as a doctor, there is very good demand for this long. 


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