Be alert to global HIV resistance
Medical Network November 24th In the mid-1990s, the emergence of anti-AIDS therapeutic drugs brought hope to the survival of HIV-infected patients. Thirty-six years after the outbreak of the AIDS epidemic in North America, the deadly disease is shrinking globally, and more than half of people infected with HIV may take symptoms for the first time.
However, a group of experts warned that the global HIV epidemic continues to exist and that the risk of HIV resistance is worrisome given that HIV antiretroviral drugs (ART) are worsening.
Drug resistance threat
“The trend toward HIV resistance is very worrying,†said Dr. Chris Beyrer, lead author of an HIV resistance status article.
"The highest level of anti-ART in infants and children exposed to ART has been found, which is a real concern because many children in developing countries have not been treated," Berel pointed out. He is a professor of epidemiology at the Johns Hopkins University Bloomberg School of Public Health in Baltimore.
Berel and his team pointed out that it is roughly estimated that there are about 19.5 million people living with HIV who are currently receiving antiretroviral treatment, accounting for about half of the global number of AIDS patients.
The goal of the United Nations and the World Health Organization is to eliminate AIDS as a public health threat by 2030. In achieving this goal, both organizations want to ensure that 90% of AIDS patients receive antiviral drugs by 2020.
However, Berel believes this will be "very difficult." On the one hand, as experts from the World Health Organization and the US Centers for Disease Control and Prevention believe, the efficacy of ART continues to increase; on the other hand, HIV resistance has risen from 11% in 2001 to 29% today.
Coping
Berel's team pointed out that the "fatal problem" is that the educational problems in the use of ART and the accessibility of medicines are seriously inadequate, and the poor compliance makes the HIV mutation and develops drug resistance.
In order to solve this problem, the team advocates accelerating the development of effective vaccines and steadily increasing the promotion and use of the AIDS preventive drug Truvada (entetaxel-tenofovir fumarate/shufatai), which is more focused on prevention.
Thousands of people have used Girard Scientific's Truvada to conduct a trial called PrEP to curb the spread of AIDS. The results show that taking Truvada daily can reduce the risk of sexually transmitted HIV infection by more than 90%.
Truvada combines two ART drugs, a fixed-dose combination oral tablet (blue pill), with sales of $3.272 billion in 2016, and the underlying patent has now expired. The Truvada imitation version produced by Mylan NV, Cipla Ltd. and Teva Pharmaceutical Industries Ltd. drastically reduced the price. In August of this year, Canada has approved a generic version of emtricitabine-tenofovir tablets (enrolito tablets). The value and market potential of the generic version of Truvada is self-evident.
Physicians and public health researchers are testing the drug's role in reducing HIV prevalence in developing countries, particularly in sub-Saharan Africa, primarily through heterosexual transmission (AIDS).
At the same time, Berel recommends the use of newer ART "cocktails" for those who have been infected but not yet treated, including dolutegravir (which has a higher genetic barrier to resistance (ie, less resistant). Drugs such as telavivir).
Berel believes that this alone "may have a major impact on the issue of resistance."
In fact, drug resistance may eventually pose a risk to Truvada, although it is currently “very rareâ€. Berel suggests: It needs to be vigilant from a regulatory perspective, and those who use Truvada should insist on treatment and reduce the chance of drug resistance.
Worried about the US reduction plan
In addition, Berel and his colleagues are worried about the threat the US government is rushing to drastically reduce the health risks to the world. Berel said: "The Trump administration's reductions will have a serious impact on HIV treatment programs, especially in Africa's poorest and most prevalent countries, and certainly in areas with poor health care in the United States. â€
"At present, the US Congress has boycotted these reduction plans." Berel hopes that the US government will continue to give priority to the support they need to ultimately control the HIV epidemic.
Dr. Annette Sohn of the global AIDS research advocacy organization amfAR said: "Agree with the author's concerns about current drug resistance trends and their characteristics. amfAR is headquartered in Bangkok, Thailand, and Thorn is the vice president of the organization.
In order to achieve real success in combating HIV resistance, it is necessary to provide the best treatment for all people living with HIV.
Thorne believes that the US government's proposed reduction of the global anti-AIDS program is an important concern. In addition, other countries cannot follow the trend. The risk of losing the treatment and stopping the medication will lead to treatment failure, more new HIV infections and increased resistance.
Funding for HIV and HIV research should not only be cut, but also require more investment, and countries should pay sufficient attention. Naturally, research should also be conducted on how to provide testing and treatment services in the most cost-effective manner.
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