TAG: GS 3: SCIENCE AND TECHNOLOGY
THE CONTEXT: The World Health Organization (WHO) has raised concerns about the increasing resistance to the antiretroviral drug dolutegravir (DTG) among HIV patients.
EXPLANATION:
- Despite being recommended by the WHO since 2018 for its effectiveness and minimal side effects, recent survey data reveals rising resistance levels, necessitating urgent global attention and coordinated action.
Rising Resistance Levels and Concerns:
- WHO Recommendation:
- Dolutegravir (DTG) has been recommended by the WHO as the preferred first- and second-line HIV treatment since 2018 due to its efficacy, ease of use, and minimal side effects.
- Resistance Data:
- Survey data from four sources indicates resistance levels ranging from 3.9-8.6%, reaching a concerning 19.6% among individuals with high viral loads who transitioned to DTG-containing antiretroviral therapy (ART).
- Importance of Vigilance:
- Director of the WHO Department of the Global HIV, Hepatitis, and STI Programmes emphasizes the need for increased vigilance and intensified efforts to optimize the quality of HIV care delivery in response to evidence of resistance in individuals with unsuppressed viral load despite DTG treatment.
Positive Developments and Challenges in HIV Response:
- The HIV Drug Resistance (HIVDR) Report highlights high levels of HIV viral load suppression (>90%) in populations receiving DTG.
- The global response to HIV faces challenges, with 1.3 million new HIV infections and 630,000 HIV-related deaths reported in 2022, deviating from Sustainable Development Goal (SDG) targets.
- Several countries fail to meet global targets for HIV treatment indicators, emphasizing the need for improved treatment and care services.
Importance of Surveillance and Data Reporting:
- The report recommends routine surveillance of HIV Drug Resistance (HIVDR) to track prevalence and patterns of resistance.
- This is critical for shaping treatment guidelines and enhancing program quality.
- Only 12 of 45 WHO focus countries integrated HIV drug resistance early warning indicators into routine monitoring systems in 2022.
- It highlighted the need for improved data reporting and surveillance.
- Instances of resistance to integrase-strand transfer inhibitors (INSTI) after exposure to cabotegravir (CAB-LA) underscore the importance of timely HIV detection.
WHO’s Support for CAB-LA and Call for Standardized Surveillance:
- Despite risks, the WHO supports the rollout of cabotegravir (CAB-LA) for pre-exposure prophylaxis (PrEP) and calls for standardized surveillance of drug resistance among individuals testing positive for HIV while on PrEP.
- Routine monitoring of quality-of-care indicators, including on-time ART pick-up and viral load testing coverage, is crucial for successful ART programs.
- The report emphasizes the necessity for strengthened data reporting systems, active engagement of ART clinics and programs, and coordinated action across all government sectors and societal levels to minimize the spread of HIV drug resistance and optimize service delivery quality.
Dolutegravir:
- Dolutegravir is used with other medications to treat human immunodeficiency virus (HIV) infection in adults and children 4 weeks of age and older who weigh at least 6.6 lbs (3 kg).
- It is also used in combination with rilpivirine (Edurant) to treat HIV in certain adults to replace their current HIV medication(s) that has been taken for at least 6 months.
- Dolutegravir is in a class of medications called HIV integrase inhibitors.