Global threat from drug resistant HIV in sub-Saharan Africa
Roll-out of antiretroviral treatment for HIV in sub-Saharan Africa has been accompanied by rising rates of drug resistance. Raph Hamers and colleagues call for improved patient management and the integration of population based drug resistance surveillance into national treatment programmes
Since its introduction 16 years ago, combination antiretroviral therapy for HIV infection has saved millions of lives. In sub-Saharan Africa, the region with the highest HIV/AIDS burden, high level political commitment and substantial international funding have led to an unparalleled scale-up of access to treatment over the past eight years.1 More than five million Africans infected with HIV are receiving antiretroviral therapy today—nearly half of those who are in immediate need.1 However, little attention has been paid to the potential emergence and spread of drug resistant HIV and its public health implications. Drug resistant HIV variants selected for during treatment failure (acquired resistance) have the potential to limit the response to subsequent treatment and constitute a reservoir for onward transmission to newly infected individuals (transmitted resistance). Drug resistant HIV may severely restrict therapeutic options, and treatment costs will greatly increase when more people need second and third line antiretroviral regimens. It is therefore important for national HIV treatment programmes to monitor and manage mounting drug resistant HIV.
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