HIV drug resistance new threat to fighting AIDS in Africa

By Gatonye Gathura

More than 13,000 Kenyans on HIV medication are staring at what doctors say are preventable deaths due to treatment failure.

For example, at their 200 bed capacity hospital in Homabay, the charity group Médecins Sans Frontiers (MSF) says half of patients are no longer responding to treatment.

“Up to 40 per cent of these are dying, a third of them within 48 hours of admission,” MSF told the 9th IAS Conference on HIV Science Paris, France last week.

Most of those dying, Charlotte Morris of MSF, UK, says, unlike 20 years ago are already on ARVs.

In Kenya, ARVs were introduced 15 years ago turning a previously death sentence into a manageable condition. But this, doctors say is changing as ARV lose their effectiveness against HIV.

“In Homa-Bay, where antiretrovirals have been available for years, half of the patients hospitalized with AIDS show signs of treatment failure,” says David Maman, of MSF.

In April the Ministry of Health, University of Amsterdam, The Netherlands, the Kenya Medical Research Institute and the US Centers for Disease Control and Prevention reported the emergence of totally untreatable HIV patients in Kenya.

“Our findings indicate that nearly one in four patients in Kenya failing second-line treatment has completely exhausted the available antiretrovirals,” said their report in the journal Aids.

Ministry of Health statistics indicate of the 900,000 Kenyans on ARVs about 180,000 are taking second line drugs.

MSF says 75 per cent of HIV patients being admitted to their facilities with advanced HIV have been on ARVs.

‘This suggests that they may have, either inherited a resistant form of the virus or their care providers have failed to notice their patients were not responding to treatment.”

These deaths can be prevented, says MSF. “Of particular importance is minimum annual viral load monitoring with quick return of results and immediate switch to the next line of treatment.”

Worried over the unfolding problem the World Health Organisation has released The WHO HIV drug resistance report 2017 which warns of a new HIV crisis.

At the Paris meeting the UN body also released guidelines on managing HIV drug resistance in poor countries.

“This new report shows a worrying picture of increasing levels of HIV drug resistance and, if unchecked, it will be a major risk to program impact,” said Dr Marijke Wijnroks, of Global Fund.

WHO want  affected counties, worst of them it says in East Africa and especially Uganda to take immediate  measures including conducting national surveys to establish the magnitude of the problem.

Kenya is planning such a survey in children later this year in which current HIV drug resistance is estimated at 15.6 per cent.

MSF is recommending the immediate switching of patients experiencing drug failure to the next line of treatment.

Secondly they recommend an annual viral load testing for all patients on ARVs, and a speedy introduction of newer and safer antiretrovirals in poor countries.

Last month the Ministry of Health launched the ARV Dolutegravir (DTG) described as safer and less likely to be resisted by the Aids virus.

During its launch in Nairobi, the head National Aids and STI Control Programme, Dr Martin Sirengo said, DTG has “fewer side-effects” and patients are less likely to develop resistance to it.