Agence France Presse (07.18.12)

HIV drug resistance in low- and middle-income nations stood at 6.8 percent in 2010, the World Health Organization said Wednesday. WHO released its first-ever report on the issue ahead of next week’s 19th International AIDS Conference. According to WHO AIDS chief Gottfried Hirnschall, "That is a level we sort of expected. It is not dramatic but we clearly need to look very carefully on how this would evolve further." WHO did not recommend a change in treatment guidelines based on the study. Drug resistance can occur when HIV mutates naturally, when treatment is interrupted, or when patients take medications incorrectly or irregularly. Approximately 8 million people in low- and middle-income countries received antiretroviral drugs last year, up 20 percent from 2010, according to a separate UNAIDS report released Wednesday. High-income countries have higher rates of resistance, from 8 percent to 14 percent. Many of these nations launched widescale treatment programs years ago, often using single- or dual-drug therapies, which can encourage resistance. However, these higher rates have largely leveled off or decreased over time. In 12 of the low- and middle-income countries in the WHO study, health care facilities lost count of up to 38 percent of people who began treatment. When people interrupt or stop treatment, "this not only means that they are themselves more likely to become sick, it also increases the likelihood that drug resistance will emerge and the resistant virus could be transmitted to others," the report said. WHO called for clinics to monitor for early warning indicators of resistance, including poor treatment adherence, supply breaks, and signs of treatment failure, such as rising viral levels in the blood. Hirnschall added, "Simpler regimens using fixed-dose combinations have made it much easier for people to adhere to antiretroviral treatment, limiting the spread of drug resistance in recent years."