Without a doubt growing bacterial and viral resistance to commonly used antibiotics and antivirals threatens to turn back the clock on what doctors can do for patients who have serious infections. A special case is that of the high mutation rate of HIV, and hence unusual agility of this virus to generate resistance to antiviral medications.
However, an article published in the Journal of Clinical Infectious Diseases has found that the incidence of HIV resistance to antiviral medications has decreased between 1996 and 2008 in a population of HIV-positive patients in British Columbia.
Any person who is HIV-positive may develop a condition called “virologic failure” in which the strains of HIV circulating within the body becomes resistance to antiviral medications due to a number of factors which include poor adherence to the medication regime (not taking the medications as frequently as ordered), medication toxicities, and even differences in how different people metabolize these medications. A given patient may develop resistance to a class of antiviral medications, or to several different classes of medications.
In many cases, virologic failure means that the patient will eventually develop AIDS as the strain of HIV circulating in his or her body has developed resistance to most classes of antiretroviral medications.
However the study, completed in British Columbia, found that HIV drug resistance dropped off significantly between 1996 and 2008, despite the continued, and increasing, exposure of HIV positive individuals to antiretroviral medications.
One reason for the drop in the HIV resistance is that the care of HIV positive patients has become progressively more sophisticated. New antiviral medications have been introduced and, perhaps more importantly, protocols for detecting resistance and altering medication regimes are becoming more refined. In addition, powerful cocktails of antiretrovirals, called HAART (or Highly Active AntiRetroviral Therapy) may suppress the level of HIV in the human body so low as to drastically impede the accumulation of resistant mutations.
While more controlled studies need to be done, the conclusions reached in this study could have broad implications for the treatment of HIV positive people in the developing world, as it appears that using antiretroviral therapy in a population can, if done properly, drive down the incidence of HIV resistance.
Many scientists have had concerns that the provision of antiretroviral medications to poor countries could lead to an explosion in the number of cases of HIV viral resistance, and hence make antiretroviral medications less effective worldwide.
Ironically, the incidence of viral resistance in developing countries may increase as funds for antiretroviral medications are cut, and hence family members may begin “sharing” their medications with those who have none. Taking antiretroviral therapy inconsistently is one patient behavior which drives up HIV resistance. The best option in terms of providing antiretroviral medications to a population, in terms of preventing HIV resistance, is that you either don’t do it, or that you provide universal access to these medications. Meaning that the only ethical solution is to provide universal access to antiretroviral medications.
This study, in addition to others, seem to indicate that people living in poor countries can effectively adhere to antiretroviral medication regimes, and furthermore, that such treatment may actually improve the issue of global HIV resistance.