HIV Drug Resistance Report 2017. Geneva: World Health Organization; 2017
(2017; 82 pages)

Abstract

Antimicrobial resistance (AMR) is a growing global public health threat, which urgently requires collective action to ensure effective prevention and treatment of infections. Minimizing the emergence and transmission of HIV drug resistance (HIVDR) is a critical aspect of the broader global response to AMR. Prevention, monitoring and response to HIVDR is key to building and sustaining gains in HIV treatment scale-up, and achieving the global 90-90-90 targets for treatment. These widely adopted targets reflect the global community’s commitment to expanding access to antiretroviral therapy (ART) including: diagnosing 90% of all people with HIV infection; providing treatment to 90% of those diagnosed; and ensuring 90% of people on treatment achieve virological suppression, by 2020. By the end of 2016, 70% of people living with HIV (PLHIV) were diagnosed,77% of those who knew their HIV status received ART, and 82% of those on treatment were virally suppressed.

The human cost of HIVDR cannot be underestimated: people with non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance are less likely to achieve viral suppression; more likely to experience virological failure or death; more likely to discontinue treatment; and more likely to acquire new HIVDR mutations. Preventing, monitoring and responding to HIVDR is therefore critical to maintaining current achievements, improving treatment outcomes for PLHIV, protecting investments, and guaranteeing the long-term sustainability of care and treatment programmes. Mathematical modelling predicts that if NNRTIs continue to be included in first-line ART regimens, and the level of pretreatment HIV drug resistance (PDR) to NNRTIs reaches above 10% in sub-Saharan Africa, the global targets to end AIDS as a public health threat by 2030 will not be attained. Achieving and sustaining “the last 90” target will therefore require efforts to contain and respond to HIVDR.

Recognizing the importance of addressing HIVDR, within the context of ART scale-up, the World Health Organization (WHO), in collaboration with partners, developed a comprehensive HIVDR surveillance approach in 2004, with guidance updated in 2014 to yield nationally representative estimates of HIVDR.

This second HIVDR report has been jointly developed by WHO, the United States Centers for Disease Control and Prevention (US-CDC) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (“The Global Fund”). It provides an update on recent population levels of HIVDR covering the period 2014–2016. The report includes data from 16 nationally representative surveys from 14 countries1 estimating resistance in: adults initiating ART (PDR), children younger than 18 months newly diagnosed with HIV, and adults on ART (acquired HIV drug resistance or ADR). To contextualize results from representative HIVDR surveys, the report is supported by systematic reviews of the published literature on PDR in adults, children and adolescents, and ADR in paediatric and adult populations. Finally, the report includes the prevalence of transmitted HIV drug resistance (TDR) in recently infected people in Malawi and Zimbabwe, estimated as part of recent household Population-based HIV Impact Assessment (PHIA) surveys, supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR).

 
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