The first antiretroviral therapy (ART) targeting HIV was introduced in 1987 , offering clinicians newfound hope in treating HIV-infected persons. The subsequent development of novel ART drug classes and the initiation of combination ART regimens mark one of the most groundbreaking medical achievements in modern times, dramatically improving the prognosis and life expectancy for HIV-positive patients. Effective ART regimens are now capable of suppressing the virus to levels that are undetectable, reducing the risk of complications and preventing progression to acquired immunodeficiency syndrome (AIDS), while also lowering transmission rates within vulnerable populations. Successful viral suppression is key to mitigating further emergence of drug resistant strains of this retrovirus, making genetic and epidemiologic HIV-1 surveillance programs essential to fighting this epidemic.
The emerging challenge of ART resistance
Over the past decade, the efficacy of some fundamental HIV treatments has been compromised due to the evolution of the HIV virus, resulting in resistance to drug therapy. To preserve the effectiveness of key ARTs and ensure HIV-positive patients receive optimized regimens, the World Health Organization (WHO) is calling on countries to establish multifaceted plans to prevent further HIV drug resistance (HIVDR) . According to the WHO, a comprehensive strategy aimed at controlling and preventing HIVDR should include all of the following:
- Reduction of HIV transmission rates
- Monitoring and suppressing viral loads in affected patients and at the population level
- Providing access to effective treatments supported by robust drug supply chains
- Prompt changing of regimens that are ineffective
- Adherence to established treatment guidelines and recommendations
- HIVDR surveillance
Surveillance efforts are especially important, as they influence multiple other HIVDR prevention tactics. Identification of drug resistance allows for the quick discontinuation of therapies that are likely to be ineffective and the subsequent initiation of effective therapies which, in turn, results in lower viral loads and reduced transmission.
WHO resources for HIVDR surveillance
The WHO released its most recent HIVDR report in November of 2021, highlighting progress in international surveillance and the need for a continued focus on this critical aspect of disease control . In support of HIVDR research and prevention, the WHO offers surveillance protocols based on specific patient populations and has developed a global HIVDR database to inform treatment guidelines and maximize regimen efficacy based on findings from countries around the world.
HIVDR surveillance activities in Africa
Africa remains the continent most widely affected by HIV infections, accounting for approximately 68% of all HIV-positive patients worldwide as of 2020 . Additionally, rural areas of sub-Saharan Africa have limited access to testing, care and treatment, establishing conditions for poor disease control and the emergence of further drug resistance . In combination, these factors make HIVDR surveillance in Africa imperative.
Since HIVDR surveillance information is only as reliable as the analytical tools used to generate it, robust platforms and associated test kits need to be made accessible to testing laboratories to support these efforts. At the African Society of Laboratory Medicine (ASLM) meeting in November 2021, speakers addressed HIVDR and outlined several key surveillance programs that are underway, as well as the technologies that are supporting them.
In separate presentations, Dr. Leonard King’wara*, from Kenya, and Dr. C.K Onwuamah**, from Nigeria, both highlighted the importance of surveillance for HIVDR and how their national programs are monitoring for emerging drug resistance in their populations. Included in these discussions are sample analyses and data using the Applied Biosystems HIV-1 Genotyping Kit ƚ by Thermo Fisher Scientific to identify resistance. This assay is designed to support the HIV epidemiologic and genetic surveillance communities in reliably sequencing the HIV-1 virus, detecting mutations associated with resistance to key ART classes of interest, including protease inhibitors, nucleoside reverse-transcriptase inhibitors, and non-nucleoside reverse-transcriptase inhibitors. In a soon-to-be-launched product, assessment of drug resistance to integrase inhibitors will be included ƚ ƚ.
The importance of surveillance in fighting HIV
The Joint United Nations Programme on HIV/AIDS (UNAIDS) recently set a new 95-95-95 target, which aims for 95% of those living with HIV to know their status, 95% of those who know their status to be on treatment and 95% of those on treatment to be virally suppressed by 2030 . Population-level surveillance programs are key to fighting the HIV epidemic and achieving this goal.
All ARTs are susceptible to reduced efficacy and resistance due to emergent HIV mutations. Through close monitoring of HIVDR patterns, the scientific and medical communities can sustain and build on the revolutionary progress that has been made in treating and monitoring HIV in recent decades. Providing equitable access to care and promoting ongoing, active surveillance are both key to ensuring HIV-positive patients can continue to thrive and live the longest, healthiest lives possible.
For more information on Africa’s HIV drug resistance surveillance efforts, please download the ASLM talks on demand.
To learn more about Thermo Fisher Scientific’s HIV genotyping solutions to support surveillance efforts and combat HIV drug resistance, visit our webpage.
*Leonard Kingwara, BSc, MPH, PhD, is the Genomic and Molecular Surveillance Lead at the Department of National Laboratory Services please state their country affiliation
**Chika Onwuamah BSc, MSc, PhD, is the Chief Research Scientist and the Team Lead for the Population Genomics and Cancer (POPGEC) Group at the Centre for Human Virology and Genomics please state their country affiliation
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