The HIV Drug Resistance Report - 2012
(2012; 84 pages)

Abstract

At the end of 2011, more than 8 million people were receiving antiretroviral therapy in low- and middle-income countries, a dramatic 26-fold increase from December 2003. Although it can be minimized, some degree of HIV drug resistance is anticipated to emerge among people on treatment even when appropriate antiretroviral therapy is provided and high levels of adherence are achieved. Therefore, WHO initiated global surveillance of HIV drug resistance in 2004 in order to adequately monitor the emergence of HIV drug resistance as countries scaled up access to antiretroviral therapy.

This report reviews data on HIV drug resistance in low- and middle-income countries between 2003 and 2010 and three main conclusions stand out. First, with the expansion of treatment achieved over the last eight years, there are signals of increasing prevalence of transmitted HIV drug resistance, particularly to non-nucleoside reverse transcriptase inhibitors (NNRTI), among recently infected populations in the areas surveyed. However, though increasing, transmitted HIV drug resistance has not occurred at the high levels some had predicted as a consequence of the rapid scale-up of antiretroviral therapy.

Second, with respect to acquired drug resistance, WHO surveys indicate that, if people are switched to second-line regimens soon after virological failure, standard second-line treatment combinations are likely to be effective for the majority of patients failing first-line therapy.

Third, drug resistance surveillance provides important information on the effectiveness of ART programmes and services. Monitoring of ART programme functioning through WHO HIV drug resistance early warning indicators in 50 countries highlight the existence of important gaps in service delivery and programme performance, particularly with respect to procurement and supply systems, adherence and clinic retention.

Although HIV drug resistance data from low- and middle-income countries are increasingly available, lack of surveillance data over time substantially limits the ability to assess trends in these countries. As ART coverage continues to grow, national programmes should perform routine surveillance of transmitted and acquired HIV drug resistance to optimize programme planning and management and to inform antiretroviral therapy policy.

 
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