HIV drug resistance is on the increase
New data from the national HIV resistance database shows that patients exhibiting drug resistance is increasing.
The number of patients with HIV infection who are resistant to all three
available classes of drugs grew from 1 per cent in 1996 to 14 per cent
in 2001 and a provisional figure of 13 per cent for 2002.
The database also shows that the proportion of people who have been infected
with a strain of HIV that is already resistant to drugs increased from
10 per cent in 1996 to 14 per cent in 2001. The provisional figure for
2002 is 21 per cent. “This shows us that a number of people are
contracting their infection from someone who is receiving or has in the
past already received drug therapy,” according to Dr Barry Evans
of the Health Protection Agency.
The database is produced by the HPA in collaboration with HIV clinics,
virology departments and academic centres, and is funded by the Department
of Health.
“Drug treatments for HIV have proved to be very successful in keeping many
of those infected in good health. However, in a small number of people the resistance
to those drugs is steadily increasing,” Dr Evans commented. “There
is still a need to continue to develop new classes of HIV drug treatments in
order to effectively treat people who are experiencing treatment failure.”
Last week, a study in The Lancet showed that predicted survival for people with
HIV has increased since the introduction of highly active antiretroviral therapy
(HAART). The risk of disease progression to AIDS was significantly reduced in
2001 (hazard ratio 0.13, 95 per cent confidence interval, 0.09–0.21). However,
some determinants of progression have changed. Before the introduction of HAART,
people who contracted HIV through injecting drugs had lower risk of progression
to AIDS than men who contracted HIV through having sex with other men. This tendency
has been reversed. In addition, older age used to be an indicator of increased
risk of disease progression but there is now little evidence of a difference
in risk by age (2003;
362:1267).
AIDS congress Data to support the use of the new HIV fusion
inhibitor enfuvirtide (Fuzeon) were presented at the European AIDS
Society
congress in Warsaw this week. A study showed that enfuvirtide is
a cost-effective option when added to optimised conventional therapy,
with a cost of £23,000 per quality-adjusted life year gained
compared with conventional therapy alone. The British HIV Association
has updated its guidelines for treating HIV to include enfuvirtide
(available at www.bhiva.org).
A second study presented at the congress showed that patients taking lopinavir/ritonavir
(Kaletra) as part of their initial treatment regimen did not develop protease
inhibitor resistance over five years.
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