Mutant First-Line Drug Resistant HIV Strains on the Rise

The fight to halt the pandemic spread of HIV has been “an extraordinary achievement in global health,” doctors wrote in the New England Journal of Medicine this week.But progress made to treat those with HIV and to stem the virus’ spread could stall, doctors said. And they point to a worrisome culprit: Mutating strains of HIV that don’t respond to the drugs doctors turn to first to treat the virus, particularly in low income and middle income countries.HIV strains that resist those common drugs — called nonnucleoside reverse transcriptase inhibitors — are on the rise, according to Dr. Chris Beyrer and Dr. Anton Pozniak, who coauthored the New England Journal of Medicine article about increasing drug resistance.

Around the world, 19.5 million people are being treated with drugs for HIV, researchers reported. That’s about half of all people infected with the virus, according to the World Health Organization.

Rising rates of resistance to common drugs among those patients could throw a wrench in the World Health Organization’s goal “to end the AIDS pandemic as a public health threat by 2030,” researchers wrote.

Since antiretroviral therapy was introduced worldwide to fight the virus around 2001, HIV drug resistance has increased from 11 to 29 percent.

One of the problems is that those who begin drug therapy to treat HIV and then stop their treatment regimen can develop drug resistant strains, the researchers wrote.

“Unfortunately, adherence is a fundamental problem,” article author Beyrer, of Johns Hopkins University, said in an audio interview with Stephen Morrissey, the managing editor of the journal. “It’s probably the Achilles’ heel.”

But another growing problem is that people who don’t adhere to their treatment regimen and develop drug-resistant HIV can then spread their drug resistant strain to others, the doctors wrote. That means that it’s getting more common for HIV cases to resist first-line drugs before patients have even been exposed to them.

“It is worrisome that in 6 of 11 countries surveyed — Argentina, Guatemala, Namibia, Nicaragua, Uganda, and Zimbabwe — the rate of pretreatment drug resistance surpassed 10% among people receiving [antiretroviral therapy to tackle HIV] for the first time,” the authors wrote.

The World Health Organization released a report earlier this year singling out drug resistance as a growing problem.

“We need to ensure that people who start treatment can stay on effective treatment, to prevent the emergence of HIV drug resistance,” Dr. Gottfried Hirnschall, Director of the World Health Organization’s HIV Department, said in a statement earlier this year about the report. “When levels of HIV drug resistance become high we recommend that countries shift to an alternative first-line therapy for those who are starting treatment.”

Luckily there are other drugs to treat HIV, and doctors are working to develop more, the researchers wrote.

Those new and more advanced classes of drugs are often expensive, though, and are easier to get in higher income countries, Beyrer said.

“What we’re of course so excited about in the U.S. … is the newer classes of drugs,” Beyrer said, adding that one class in particular “has a very high genetic resistance barrier and is likely to be a game changer.”