ART-A

Description

HIV drug-resistance is a negative side-effect of widespread medication use of antiretrovirals, which have to be taken for life. Just think how difficult it is for most people to finish a simple antibiotic therapy of a week, or how many people stop their malaria prophylaxis once they return from their holidays. The negative effects can be seen in the fight against malaria and tuberculosis (TB). Very recently outbreaks have been recorded in Thailand and Cambodia of malaria parasites that are fully resistant to all drugs, including the “wonder drug” artemisinin. In the case of TB, outbreaks of multi-resistant tuberculosis strains are frequent and increasingly threatening.

Compared to malaria and TB, HIV mutates and replicates even faster and it is therefore not hard to predict that large-scale development of HIV-drug resistance is looming. This is particularly true for Africa, where health systems are constrained and generally health care is severely underfunded. Poorly operating health systems can lead to reduced patient drug adherence, which is the single most important reason why resistance develops. Drug resistance can seriously undermine the long-term effects of antiretroviral therapy (ART) and thus seriously challenge the international efforts of providing ART to the developing world.

HIV drug resistance can be measured by certain laboratory tests. However, these tests are technically complex and prohibitively expensive for use in low-resource settings such as Africa. Moreover, this continent particularly suffers from a massive infection rate with an extraordinary large variety of HIV. This further complicates HIV drug resistance testing and underscores the importance of collecting more information in Africa.