{"id":2289,"date":"2018-10-11T15:39:48","date_gmt":"2018-10-11T15:39:48","guid":{"rendered":"https:\/\/www.mybiosource.com\/learn\/?p=2289"},"modified":"2023-03-06T13:27:20","modified_gmt":"2023-03-06T13:27:20","slug":"std-series-hiv-drug-resistance-and-fighting-the-the-ultimate-challenge","status":"publish","type":"post","link":"https:\/\/www.mybiosource.com\/learn\/std-series-hiv-drug-resistance-and-fighting-the-the-ultimate-challenge\/","title":{"rendered":"STD Series: HIV Drug Resistance and Fighting the ultimate challenge"},"content":{"rendered":"

Table of Contents<\/strong><\/span><\/h2>\n

I. Introduction<\/strong>
\n\u2022 Number of people living with HIV
\n\u2022 Antiretroviral therapy and drug resistance
\n\u2022 Impact of drug resistance in low-middle income countries
\nII. Types of HIV Drug Resistance (HIVDR)<\/strong>
\n\u2022 Acquired HIVDR
\n\u2022 Transmitted HIVDR
\n\u2022 Pretreatment HIVDR
\nIII. HIV Drug-resistance testing<\/strong>
\n\u2022 Genotypic Assays
\n\u2022 Phenotypic Assays
\n\u2022 Viral load testing
\nIV. Challenges of Health-Care Providers<\/strong>
\n\u2022 Results of WHO online survey of healthcare workers
\n\u2022 Challenges in changing to non-NNRTI-containing first-line regimen
\n\u2022 Preferred and alternative regimens by age and drug class
\nV. Treatment scope<\/strong>
\n\u2022 2016 WHO consolidated ARV guideline for first-line ART regimens
\nVI. Conclusion<\/strong><\/p>\n

\n

An estimated 36.7 million people in the world today are living with HIV<\/span>, and around 19.5 million people are undergoing antiretroviral therapy<\/span>. Though the treatment is highly effective in managing the illness, an increased number of patients are currently experiencing drug resistance.<\/p>\n

HIVDR occurs with a mutation of HIV<\/span> thus affecting the ability of drugs to prevent the replication of the virus. It is a severe threat particularly in sub-Saharan Africa and other low-middle income countries where poor access to diagnostics can make the management of the disease even more challenging.<\/p>\n

The current antiretroviral (ARV) drugs including the newer classes are at the risk of becoming wholly or partially inactive due to the drug-resistant virus. This risk affects the success rate of an effective treatment for HIV<\/span> and preventing the target to end AIDS<\/span> epidemic as a global threat. In 2016, WHO guidelines on the use of antiretroviral drugs as the treatment of HIV<\/span> infection recommended treating everyone diagnosed with HIV<\/span> regardless of the CD4<\/span> count. The recommended first-line ART<\/span> regimen for HIV<\/span> patients is based on non-nucleoside reverse transcriptase<\/span> inhibitors (NNRTI<\/span>). World Health Organization<\/span> in 2017 has recommended an alternative treatment particularly for countries with drug resistance prevalence at above 10%.<\/p>\n

Types of HIV<\/span> Drug Resistance (HIVDR) <\/strong><\/p>\n

Acquired HIVDR- This occurs with HIV<\/span> mutation developing among individuals receiving the treatment with ARV drug. It can be of poor health service quality, treatment interruptions, sub-optimal treatment adherence or insufficient drug concentrations in the body.<\/p>\n

Transmitted HIVDR – This occurs when an uninfected individual with no history of exposure to ARV drug is infected with a drug-resistant strain of HIV<\/span> from an individual with HIVDR mutations<\/span>.<\/p>\n

Pretreatment HIVDR<\/em> – It is detected among those with no history of ARV drug or reinitiating first-line ART<\/span> therapy after treatment interruption. It can also be the result of either acquired, transmitted HIVDR or both. With ARV drugs as the treatment option among HIV<\/span> infected individuals, an increase in pretreatment HIVDR has been confirmed by various nationally representative surveys.<\/p>\n

HIV<\/span> Drug-resistance testing<\/strong><\/p>\n

HIV<\/span> drug resistance test identifies the drugs no longer effective against an individual\u2019s strain of HIV<\/span>. Normally, the drug resistance test is performed before the initiation of HIV<\/span> treatment in order to detect infection with a drug-resistant strain of HIV<\/span> and also to select suitable treatment strategies as the first HIV<\/span> regime.\u00a0 The testing can deliver information on resistance to nucleoside reverse transcriptase<\/span> inhibitors (NRTIs), non-nucleoside reverse transcriptase<\/span> inhibitors (NNRTIs), integrase strand transfer inhibitors (INSTIs) and protease inhibitors<\/span> (PIs).<\/p>\n