SWITZERLAND—The World Health Organization (WHO) has released the HIV Drug Resistance (HIVDR) Report, which shows an increase in HIV drug resistance. 

The report demonstrates remarkable levels of HIV viral load suppression  of above 90% in persons receiving dolutegravir (DTG)-containing antiretroviral treatment (ART), with observational and country-generated survey data indicating that HIVDR to DTG levels are higher than those observed in clinical trials.

Since 2018, dolutegravir has become the preferred first- and second-line HIV treatment for all population groups since it is more effective, easier to take, and has fewer adverse effects than other medications now in use.

Furthermore, it has a high genetic barrier to developing drug resistance; however, four surveys found that resistance to dolutegravir ranged from 3.9% to 8.6%, reaching 19.6% among people who received treatment and transitioned to a DTG-containing ART while having high HIV viral loads.

Haiti was the only country to provide data from an HIVDR survey among ART-naïve infants or infants receiving ART for the first time show that an infant, whose mother had received DTG-based ART, was reported to exhibit DTG resistance.

In 2022, more than 75% of the 39 million people living with HIV were receiving HIV treatment, with 116 of the 127 countries adopting DTG-based treatment for adults and adolescents, and 74% of reporting low- and middle-income countries implementing viral load monitoring for adults and adolescents.

Furthermore, only 12 of 45 WHO priority countries reported completing surveys or incorporating HIVDR early warning signs into routine monitoring and evaluation systems that same year.

This is due to the fact that many countries continue to fall short when it comes to maximizing patient retention, population-level viral load suppression, and moving people with virological failure to new regimens. 

Additionally, antiretroviral medicine stockouts continue to occur, which may have a negative influence on patient treatment adherence.

The report also describes examples of resistance to integrase-strand transfer inhibitors (INSTIs) following recent cabotegravir (CAB-LA) exposure, with delayed HIV testing and confirmation thought to increase the chance of developing INSTI resistance.

Since 2022, WHO has recommended long-acting injectable CAB-LA as a supplementary HIV prevention option for people who are at high risk of HIV infection.

However, progress toward the SDG targets has halted, with an anticipated 1.3 million new HIV infections and 630 000 deaths from HIV-related causes, highlighting the importance of aggressively improving the quality of HIV treatment and care services.  

While releasing the report, Dr. Meg Doherty, Director, WHO Department of the Global HIV, Hepatitis, and STI Programmes, noted that this worrying evidence of resistance in individuals with unsuppressed viral load despite dolutegravir treatment highlights the need for increased vigilance and intensified efforts to optimize the quality of HIV care delivery.

She also stated that standardized tracking of HIV drug resistance is critical for efficiently preventing, monitoring, and responding to these difficulties.  

The new HIVDR report underlines the necessity of improving data reporting systems so that nations may properly monitor and report on quality-of-care metrics.

It emphasizes the active participation of ART clinics and programmes in the utilization of indicator data to generate locally acceptable and sustainable solutions, which are critical for improving service delivery quality and limiting the spread of drug-resistant HIV.

Minimizing the spread of HIV medication resistance is an important component of the larger global response to antimicrobial resistance, which requires coordinated effort across all government sectors and levels of society. 

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