Resistance to the antiretroviral drug dolutegravir (DTG) is increasing among HIV patients, posing challenges to HIV treatment programs worldwide. This report by the World Health Organization (WHO) sheds light on the escalating resistance levels, its implications, and the necessary responses.
Implications of Dolutegravir Resistance:
- Since 2018, WHO recommended dolutegravir as preferred first- and second-line HIV treatment due to its efficacy, ease of use, and minimal side effects.
- However, survey data from multiple sources indicate increasing resistance levels, ranging from 3.9% to 8.6%, with peaks at 19.6% among individuals with high viral loads transitioning to DTG-containing antiretroviral therapy (ART).
- Dr Meg Doherty, director of WHO’s Global HIV, Hepatitis, and STI Programmes, emphasizes the necessity for enhanced vigilance and efforts to optimize HIV care delivery quality in light of this evidence.
Positive Developments and Concerns:
- The HIV Drug Resistance (HIVDR) Report notes high levels of HIV viral load suppression (>90%) in populations receiving DTG.
- A unique case in Haiti highlights resistance in an infant born to a mother on DTG-based ART, emphasizing the importance of managing high viral loads in pregnant and breastfeeding women to prevent HIV transmission.
Challenges in the Global Response to HIV:
- Despite progress, the global response to HIV faces challenges, with 1.3 million new HIV infections and 630,000 HIV-related deaths reported in 2022.
- Many countries fail to meet established global targets for HIV treatment indicators, necessitating improved quality of treatment and care services.
Recommendations and Responses:
- Routine surveillance of HIVDR is recommended to track prevalence and patterns of resistance, critical for shaping treatment guidelines and improving program quality.
- Instances of resistance to integrase-strand transfer inhibitors (INSTI) after exposure to cabotegravir (CAB-LA) underscore the importance of timely HIV detection.
- Despite risks, WHO supports the rollout of CAB-LA for pre-exposure prophylaxis (PrEP), advocating for standardized surveillance of drug resistance among individuals testing positive for HIV on PrEP.
Importance of Quality-of-Care Indicators:
- Routine monitoring of quality-of-care indicators, such as on-time ART pick-up and viral load testing coverage, is crucial for successful ART programs.
- Strengthened data reporting systems and active engagement of ART clinics and programs are essential for optimizing service delivery quality and reducing the emergence of drug-resistant HIV.
Call for Coordinated Action:
- The global response to minimize HIV drug resistance requires coordinated action across all government sectors and society levels.
Multiple Choice Questions (MCQ):
- What percentage of HIV patients showed resistance to dolutegravir according to the WHO report?
- A) 1.3% – 3.5%
- B) 3.9% – 8.6%
- C) 10% – 15%
- D) 20% – 25%
- Answer: B) 3.9% – 8.6%
- What positive development was highlighted in the HIV Drug Resistance Report?
- A) Decrease in HIV incidence rates
- B) High levels of HIV viral load suppression in populations receiving DTG
- C) Elimination of HIV-related deaths
- D) Complete eradication of drug-resistant HIV strains
- Answer: B) High levels of HIV viral load suppression in populations receiving DTG
- Which country reported a unique case of resistance to DTG in an infant born to a mother on DTG-based ART?
- A) Brazil
- B) Haiti
- C) South Africa
- D) India
- Answer: B) Haiti
- What is emphasized regarding the response to minimize the spread of HIV drug resistance?
- A) Individual efforts
- B) Government intervention only
- C) Coordinated action across all government sectors and society levels
- D) Exclusively medical interventions
- Answer: C) Coordinated action across all government sectors and society levels