WHO Report Flags Rising HIV Drug Resistance to Dolutegravir.

By Uzman Unis Bah

The World Health Organization (WHO) has released its latest HIV Drug Resistance (HIVDR) Report, shedding light on both advancements and challenges in the global fight against HIV/AIDS. While the report celebrates significant achievements in viral load suppression among populations receiving dolutegravir (DTG)-containing antiretroviral therapy (ART), it also raises alarm over escalating levels of resistance to DTG.

DTG has been endorsed by WHO since 2018 as the preferred first- and second-line HIV treatment worldwide due to its efficacy and reduced side effects. However, recent data indicate a troubling surge in HIVDR to DTG, surpassing levels observed in clinical trials.

According to the report, resistance levels range from 3.9% to 8.6%, spiking to 19.6% among individuals transitioning to DTG-containing ART with high viral loads. These findings underscore the urgent need for heightened surveillance and strategies to optimize HIV care delivery.

Furthermore, the report highlights Haiti as the sole country reporting DTG resistance among ART-naïve infants, emphasizing the critical importance of managing viral loads in pregnant and breastfeeding women to prevent mother-to-child transmission.

Despite progress in HIV treatment, global targets remain elusive, with millions still grappling with new infections and AIDS-related deaths. Many countries struggle to meet established treatment quality benchmarks, emphasizing the imperative for enhanced care services.

WHO advocates for standardized surveillance of HIVDR to inform treatment guidelines and enhance program quality. The report also addresses resistance to integrase-strand transfer inhibitors (INSTIs), stressing early detection and surveillance as crucial.

As WHO promotes the rollout of long-acting injectable cabotegravir (CAB-LA) for HIV prevention, it underscores the necessity of surveillance to mitigate resistance risks. Routine monitoring of care quality indicators remains pivotal for the success of ART programs.

Strengthening data reporting systems and community engagement are deemed essential for optimizing service delivery quality and combating drug-resistant HIV. Addressing HIV drug resistance is integral to the broader global response to antimicrobial resistance, necessitating coordinated action across sectors and societal levels.

The African region, home to an estimated 25.6 million people living with HIV, is particularly impacted by HIVDR. With East and Southern Africa accounting for 20.8 million cases and West and Central Africa for 4.8 million, the region faces significant challenges in curbing the spread of the virus.

In 2022 alone, approximately 380,000 individuals succumbed to AIDS-related illnesses, while 760,000 new HIV infections were recorded. Rapid diagnostic tests play a crucial role in facilitating HIV diagnosis, enabling timely intervention and treatment initiation.

Key populations, including men who have sex with men, people who inject drugs, sex workers, and transgender individuals, comprise over half of all new infections. Legal and social barriers exacerbate their vulnerability to HIV, highlighting the need for targeted interventions and support.

Although a cure remains elusive, effective antiretroviral drugs can manage the virus and reduce transmission risk, enabling individuals to lead healthier and more productive lives. Currently, 79% of people with HIV are aware of their status, and globally, 23.3 million receive antiretroviral therapy.

The remarkable progress in HIV/AIDS response is attributed to concerted efforts by national HIV programs, supported by civil society and various development partners. However, funding gaps pose a significant challenge, with resources falling short of the required amount.

In 2022, funding for HIV programs in low- and middle-income countries totaled US$ 20.8 billion, a 2.6% decrease from the previous year and well below the target of US$ 29.3 billion by 2025. Although domestic sources accounted for 60% of funding, international contributions saw a decline.

The United States Government remains a major contributor, providing 58% of bilateral funding, while the Global Fund to Fight AIDS, Tuberculosis, and Malaria contributes 29%. Nevertheless, there's a pressing need to bridge the funding gap, particularly for HIV prevention programs targeting key populations.

The WHO report underscores the urgency of addressing rising HIV drug resistance to safeguard the gains made in combating the epidemic. Enhanced surveillance, optimized care delivery, and sustained funding are imperative to mitigate the impact of drug-resistant HIV and accelerate progress towards ending AIDS by 2030.