The increase of antibiotic resistance (AMR) is one of the greatest threats to human health. If not dealt with urgently, the problem of drug resistance may lead to millions of deaths and increase new difficult to treat infections, thus pushing up the cost of treatment.
For the world's major public health problems, the problem of drug resistance is no exception. WHO (WHO) recently published the 2019 edition of HIV resistance report, noting that the two key anti HIV drugs, Efavirenz, and nevirapine (Nevirapine), are increasing in drug resistance.
The report points out that the fight against antimicrobial resistance, including the threat of drug-resistant HIV, is a major goal of the global community.
HIV resistance (HIVDR) is caused by one or more mutations in HIV, which affects the ability of drugs or drug combinations to prevent viral replication. At present, people who are infected with HIV usually receive cocktail therapy, that is, antiretroviral therapy. The report said that due to the emergence of drug-resistant viruses, all antiretroviral (ARV) drugs, including newer drug categories, are at risk of partial or complete failure.
It is worth noting that not only people receiving antiretroviral therapy will develop resistance, but other groups will also be infected with HIV that is already drug-resistant.
The who survey shows that in the past 4 years, who has conducted surveys in clinics randomly selected in 18 countries and examined the drug resistance level of patients who began receiving HIV treatment during this period.
Among them, in 12 countries (Aars Waed Ni, Namibia, Uganda, South Africa, Zimbabwe, Argentina, Cuba, Guatemala, Honduras, Nicaragua, Papua, New Guinea and Nepal), more than 10% of HIV infected adults were found to be resistant to weir and nevirapine.
Generally speaking, beyond this 10% threshold, it is not safe to give the same HIV drug to other people, because drug resistance may increase.
Massimo ghidinelli, an infectious disease expert at the Pan American Health Organization (PAHO), based in Washington, said, 'I think it's over the threshold now.'
The report also mentions that in particular, the level of drug resistance of infants infected with HIV in sub Saharan Africa is also very high. Between 2012 and 2018, about half of newly diagnosed infants in 9 countries in the region were infected with one or both of them, according to either one or both nevirapine.
Silvia bertagnolio, a who infectious diseases physician and one of the report's authors, said the causes of drug resistance remained elusive. But she mentioned that when people discontinue treatment, drug-resistant HIV is likely to develop.
For example, many women with the virus may take antiretroviral drugs during pregnancy to prevent infection in their infants, but stop taking them after delivery. In 2015, who recommended that pregnant and lactating women use drugs for life.
The data showed that the probability of drug resistance (21%) in the population who re used faviren and nevirapine after treatment interruption was much higher than that in the population who used it for the first time (8%).
As for people who take HIV, why do they stop taking drugs? Bertagnolio says, "shame" is a big reason. They may not want to be seen taking their medicine. The report also points out that the shortage of drugs in clinics may also be one of the reasons.
It is worth noting that who has recommended that according to the new evidence of risk and benefit, it is recommended that the anti HIV drug dolutegravir be selected as the first line and second-line treatment for all groups, including pregnant women and fertile potential populations.
Who believes that although studies have shown that women who use dulutvir during pregnancy may cause neural tube defects in their infants (natural defects in the brain and spinal cord that lead to problems such as spina bifida). However, large clinical trials show that this drug is more effective and more tolerated than other therapies.
Roger Paredes, an infectious disease doctor at the University Hospital of Trias Puyol in Barcelona, Spain, said that compared with other antiretroviral drugs, dulutvir is less likely to mutate and eventually develop drug resistance. He added, 'we must encourage the global transition to dorut graves.'
The WHO statistics show that in 2019, 82 low-income and middle-income countries reported that they were moving forward with the use of the French HIV treatment programme.
Bertagnolio agreed, but called for caution. If the treatment is not implemented well or comprehensively, new drug resistance may appear. " We don't want to end up in the same situation again. "