A new report released by the World Health Organisation has revealed an increase in HIV drug resistance to dolutegravir, a drug that has been a first-line regimen for adults and adolescents.
According to the report documenting four surveys, levels of resistance to dolutegravir ranged from 3.9% to 8.6%, and reached 19.6% among people experienced with treatment and transitioned to a DTG-containing ART while having high HIV viral loads.
While the report contains positive news Indicating high levels of HIV viral load suppression (>90%) in populations receiving dolutegravir (DTG)-containing antiretroviral therapy (ART), observational and country-generated survey data reveals that levels of HIV drug resistance to DTG are exceeding levels observed in clinical trials.
“The worrying evidence of resistance in individuals with unsuppressed viral load despite dolutegravir treatment underscores the necessity for increased vigilance and intensified efforts to optimize the quality of HIV care delivery,” said Dr Meg Doherty, Director, WHO Department of the Global HIV, Hepatitis and STI Programmes. “Standardized surveillance of HIV drug resistance is essential for effectively preventing, monitoring, and responding to these challenges”. Doherty added.
Since 2018, WHO has recommended use of dolutegravir as the preferred first- and second-line HIV treatment for all population groups. The drug is deemed more effective, easier to take, and has fewer side effects than other drugs currently in use and has a high genetic barrier to developing drug resistance.
The report also documents cases of resistance to integrase-strand transfer inhibitors (INSTIs) after recent exposure to cabotegravir (CAB-LA). Delayed detection and confirmation of HIV infection can increase the risk of developing resistance to INSTIs. Since 2022, WHO has recommended the use of long-acting injectable CAB-LA as an additional HIV prevention option for people at substantial risk of HIV infection.
The new HIVDR report emphasizes the importance of strengthening data reporting systems so that countries can effectively monitor and report quality-of-care indicators. It underscores the active engagement by ART clinics and programmes in use of indicator data to develop locally appropriate and sustainable solutions which it says are crucial for optimizing service delivery quality, thereby reducing the emergence of drug-resistant HIV.
According to latest report by the National Syndemic Disease Control Council, there were 1,377,784 Kenyans living with HIV in 2023, with 57 percent coming from 10 counties, namely; Kisumu (128,091), Nairobi (124,609), Homa Bay (120,600), Siaya (96,297), Migori (76,053), Nakuru (57,635), Mombasa (50,656), Kakamega (48,733), Kiambu (45,917) and Kisii (42,210).
The report indicate that the country recorded substantial decline in AIDS-related deaths between 2013 and 2022, attributed to the availability and access to anti-retroviral treatment.
