Who Releases Hiv Drug Resistance Report 2021
WHOs latest HIV Drug Resistance Report gives an in-depth picture of the extent to which drug resistance is growing, and the steps that countries are taking to ensure people will receive effective medicine to treat and prevent HIV.
The report reveals that in 2020, 64% of focus countries had national action plans to prevent, monitor and respond to HIV drug resistance. These plans are informed by the Global Action Plan on HIV drug resistance 20172021, a multi-stakeholder plan coordinated and published by WHO.
WHO encourages countries to monitor resistance and recommends that for people starting antiretroviral drugs called pretreatment HIV drug resistance . WHO recommends that when PDR to non-nucleoside reverse transcriptase inhibitors such as nevirapine and efavirenz reaches a threshold of 10% for a surveyed country, then the first-line HIV treatment should be urgently changed to a more robust dolutegravir-containing regimen.
This report indicates that an increasing number of countries are reaching the 10% threshold of PDR HIV drug resistance to NNRTI and people who have had previous exposure to antiretroviral drugs are three times more likely to demonstrate resistance to the NNRTI drug class. These findings emphasize the need to accelerate the transition to dolutegravir-containing regimens in countries that continue to use NNRTI-based antiretroviral therapy.
This report will be discussed during a webinar organized as part of the World Antimicrobial Awareness Week 2021.
How Do Hiv/aids Medicines Work
HIV/AIDS medicines reduce the amount of HIV in your body, which helps by:
- Giving your immune system a chance to recover. Even though there is still some HIV in your body, your immune system should be strong enough to fight off infections and certain HIV-related cancers.
- Reducing the risk that you will spread HIV to others
Goals And Principles Of Antiretroviral Therapy
To review, the overarching goal of ART is to reduce further disease and early death from HIV/AIDS, as well as to prevent transmission of HIV to others .
- ART should be offered to all HIV-1 infected patients, regardless of immune status.
- Highly effective ART regimens, such as those found in the DHHS HIV guidelines, should be considered for initial treatment.
- Drug therapy should always be patient-specific and determined based on kidney and liver function, HBV status, cardiovascular risk, child-bearing potential, drug resistance testing, genotype/phenotype, and HLA-B*5701 status .
- Therapy should be directed by clinicians with significant experience in HIV treatment.
- Patient education and importance of therapy adherence should be emphasized at the point of care.
- Caregiver education should be considered, if needed.
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What People With Hiv Should Know About The New Medications
Dr. Kristin Englund, an infectious disease specialist at Cleveland Clinic, told Healthline that, as with any medication, people looking into these new drugs should check in with their doctors about what makes for the most appropriate treatment.
Choosing a medication regimen is complex and depends upon numerous factors such as a patients other medical issues, potential side effects, and drug interactions, Englund added. With more options available, an initial antiretroviral treatment plan can be better tailored to the individual.
While often in the news, the intricacies of HIV remain fairly misunderstood by the general public.
What are antiretroviral medications, for instance?
These are drugs designed to treat retroviruses like HIV. A retroviruss genetic material is made up of RNA instead of DNA. When a retrovirus infects a cell, it uses enzymes to convert its RNA to DNA, mixing its viral DNA with the original DNA of the otherwise healthy host cell. This is what enables the retrovirus to replicate and spread, according to the U.S. Department of Health and Human Services.
Future Directions For Hiv Treatment Research
A major goal of NIAID-supported research on HIV treatment today is to develop long-acting therapies thatunlike current antiretrovirals, which require daily dosingcould be taken only once a week, once a month, or even less often. Such long-acting therapies might be easier for some people to stick to than daily pills, and might also be less toxic and more cost effective. The three types of agents under study are long-acting drugs, broadly neutralizing antibodies, and therapeutic vaccines.
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Hiv Doesnt Have To Be A Terminal Illness
Nearly forty years ago the world was just becoming aware of a new syndrome experts called Acquired Immune Deficiency Syndrome, or AIDS. They had no idea what caused it, how it spread or what to treat it with. People diagnosed with HIV in the early 1980s were lucky to survive 8 years.
But 40 years of dedicated research brings results. There are dozens of different drugs available now to treat the HIV virus. If these drugs are started early, taken exactly as recommended by a doctor, and give good viral suppression, then the chances of developing AIDS are dramatically reduced.
In fact, people with HIV are likely to have a lifespan generally the same as uninfected people and are more likely to die of other causes, such as heart disease or cancer.
Condoms Should Still Be Used During Pregnancy
Condoms not only protect against pregnancy, they also protect against HIV and other sexually transmitted infections.
Women who are pregnant are at higher risk of getting HIV than women who are not pregnant. This means that your unborn baby is also at a very high risk of acquiring the disease. So its important to still use condoms when you are pregnant, and if your partner has HIV, ask your doctor about taking Truvada which offers further protection for you and your baby.
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Hiv Advances: One Convienent Pill
HIV treatments involve several antiretroviral therapy medications, often combined into one convenient pill. Combination treatments:
- make it easier to stay on course
- fight drug resistance
- are often given once-a-day.
No more taking handfuls of pills every few hours.
Experts recommend starting HIV treatment as soon as diagnosed, regardless of the T-cell count .
Plus, many of the latest combinations are recommended to be used in “treatment-naive” patients — that is, patients who have never received any HIV medication. HIV drug-resistance testing is recommended in all patients.
Taf: The Latest Tenofovir
Tenofovir disoproxil fumarate is a Nucleotide Reverse Transcriptase Inhibitor used in combination with other HIV medicines for treatment and for prevention with a PrEP regimen.
The latest approved form of tenofovir is called tenofovir alafenamide . TAF may have some safety advantages over TDF. TAF was first approved in November 2015 and is found in several HIV pills, such as:
But what are the advantages for TAF compared to TDF?
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Future Directions For Developing Daily Hiv Drugs
At the same time, NIAID continues to support research to develop new drugs with unique mechanisms of action for daily antiretroviral therapy. Such drugs likely would be effective against HIV strains with resistance to other drug types.
For example, basic NIAID-supported research contributed to development of the experimental drug islatravir , which belongs to a class of drugs known as nucleoside reverse transcriptase translocation inhibitors, or NRTTIs. NIAID research also contributed to the development of maturation inhibitors, investigational drugs that target the same stage of the HIV lifecycle as protease inhibitors but act by a different mechanism.
Researchers also are attempting to target other parts of the HIV lifecycle. For example, the experimental inhibitor fostemsavir blocks HIV from infecting immune cells by attaching to the gp120 protein on the virus surface. Another example is development of capsid assembly inhibitors, which halt construction of the viral capsid, the protein shell that encloses HIVs genetic material.
The Latest On Hiv Care Cure And Prep
The COVID-19 pandemic has overshadowed innovations in HIV care and prevention, says Tonia Poteat, PhD, MPH, PA-C, a primary HIV care and HIV preexposure prophylaxis clinician and associate professor of social medicine at the University of North Carolina, Chapel Hill. So even though the US Food and Drug Administration approved monthly injections of cabotegravir/rilpivirine in January, none of her patients are taking it.
“We moved our clinic three times during the pandemic,” Poteat said. “I’m really interested in how on earth we’re going to integrate injectable products into our workflow. We don’t have systems set up yet, so we’re in the process of figuring out what the structure is going to be like. We have people who are interested on a wait list.”
Indeed, in an HIV world still reeling from the dual impact of HIV and COVID-19, the International AIDS Society Conference on HIV Science will bring a more coherent narrative on the future of HIV treatment and prevention. That narrative involves long-acting treatment and setting up the systems to make it available to everyone. And IAS offers data showing exactly how much people living with HIV risk poor COVID-19 outcomes.
The conference will be online for the second year in a row and, unlike in 2020, the focus will be much more on HIV treatment and prevention than on that other big infectious disease making news these days.
International AIDS Society Conference on HIV Science . To be held July 18-21, 2021
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Advances In Hiv/aids Research
For an update on what medical science is doing to fight the global HIV/AIDS pandemic, read a Parade article by NIH Director Francis S. Collins and NIAID Director Anthony S. Fauci, AIDS in 2010: How We’re Living with HIV.
Over the past several decades, researchers have learned a lot about the human immunodeficiency virus and the disease it causes, acquired immunodeficiency syndrome . But still more research is needed to help the millions of people whose health continues to be threatened by the global HIV/AIDS pandemic.
At the National Institutes of Health, the HIV/AIDS research effort is led by the National Institute of Allergy and Infectious Diseases . A vast network of NIAID-supported scientists, located on the NIH campus in Bethesda, Maryland, and at research centers around the globe, are exploring new ways to prevent and treat HIV infection, as well as to better understand the virus with the goal of finding a cure. For example, in recent months, NIAID and its partners made progress toward finding a vaccine to prevent HIV infection. Check out other promising areas of NIAID-funded research on HIV/AIDS at .
Find out more about these discoveries and what they mean for improving the health of people in the United States and all around the globe.
Find out more about these discoveries and what they mean for improving the health of people in the United States and all around the globe.
Continuing The Quest For An Hiv Vaccine
Despite all the progress in HIV treatment, development of an effective HIV vaccine has proved to be elusive. But vaccine research continues. Janssens late-stage, mosaic-based vaccine candidate, which is expected to see initial results from the phase 2b Imbokodo study as early as this year. As of July last year, all 2,600 patients in the study have been fully vaccinated.
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Recommended Regimens For Treatment
The Dept of Health and Human Services Panel on Antiretroviral Guidelines for Adults / Adolescents classifies the following regimens as recommended initial regimens for most people with HIV :
- Bictegravir, tenofovir alafenamide and emtricitabine –
- Dolutegravir, abacavir and lamivudine — only for individuals who are HLA-B5701 negative and without chronic hepatitis B virus coinfection
- Dolutegravir plus emtricitabine OR lamivudine plus tenofovir alafenamide OR tenofovir disoproxil fumarate .
- Dolutegravir and lamivudine – – except for individuals with HIV RNA > 500,000 copies/mL, HBV co-infection, or in whom ART is to be started before the results of HIV genotypic resistance testing for reverse transcriptase or HBV testing are available.
- Raltegravir plus emtricitabine OR lamivudine plus tenofovir alafenamide OR tenofovir disoproxil fumarate .
Regimens may be updated as new approvals become available. See the full Guidelines to view Initial Regimens in Certain Clinical Situations . For individuals of childbearing potential, see Table 6b before prescribing one of these regimens.
Selection of a regimen for a particular patient should be guided by factors such as virologic efficacy, toxicity, pill burden, dosing frequency, drug-drug interaction potential, resistance test results, comorbid conditions, access, and cost.
Does Art Cause Side Effects
Like most medicines, antiretroviral therapy can cause side effects. However, not everyone experiences side effects from ART. The HIV medications used today have fewer side effects, fewer people experience them, and they are less severe than in the past. Side effects can differ for each type of ART medicine and from person to person. Some side effects can occur once you start a medicine and may only last a few days or weeks. Other side effects can start later and last longer.
If you experience side effects that are severe or make you want to stop taking your HIV medication, talk to your health care provider or pharmacist before you miss any doses or stop taking the medication. Skipping doses or starting and stopping medication can lead to drug resistance, which can harm your health and limit your future treatment options.
Some side effects of ART that are most commonly reported include:
- Nausea and vomiting,
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Gaining More Coverage For Hiv Prevention Medication
As the HIV community awaits for the approval of long-acting injectable cabotegravir, a new rule will make current HIV prevention treatments more accessible. Private insurers are now gearing up to offer full coverage for these treatments, also known as PrEP, including Gileads Truvada and Descovy, as well as Tevas newly available generic version of Truvada, for patients at high risk of acquiring HIV.
Coverage of PrEP, which reduces the risk of acquiring by HIV by more than 90%, will likely have significant implications for many patients at risk of HIV, as out-of-pocket costs for the treatments can run patients $1,000 each year even with insurance because insurance does not always cover the full price of the treatment.
The move follows the U.S. Preventive Services Task Forcean independent panel that reviews the effectiveness of and provides recommendations for preventive servicesgiving PrEP for HIV prevention an A recommendation back in 2019. Under the ACA, most insurers must cover preventive services that receive an A or B rating from the group.
Combatting Hiv Requires More Than Treatment
A large part of the global effort to combat HIV has been raising public awareness of the condition, designing diagnostic tests and promoting their use, and the development and adoption of preventative drugs, known as PrEP . Smith explained that, in addition to being used for the treatment of HIV, ViiVs long-acting cabotegravir regimen is also being developed for HIV prevention. Long-acting cabotegravir is currently under evaluation as PrEP in two trials: HPTN 084 and HPTN 083. In 2020, it was reported that the PrEP regimen of cabotegravir injections given every eight weeks was safe and superior to daily oral tenofovir/emtricitabine for HIV prevention in HPTN 084.9 Due to efficacy, the independent Data Monitoring Committee recommended that the study be stopped early. In May 2020, HPTN 083 was also stopped early due to efficacy, after investigators found there were three times as many HIV infections in the TDF/FTC arm than in those receiving cabotegravir injections every eight weeks. A total of 50 incident HIV infections occurred in HPTN 083, with 38 incident HIV infections in the TDF/FTC arm and 12 incident HIV infections in the cabotegravir arm.9,10,11
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Start Treatment As Soon As Possible After Diagnosis
- HIV medicine is recommended for all people with HIV, regardless of how long theyve had the virus or how healthy they are.
- Talk to your health care provider about any medical conditions you may have or any other medicines you are taking.
- Let your health care provider know if you or your partner is pregnant or thinking about getting pregnant. They will determine the right type of HIV medicine that can help prevent transmitting HIV to your baby.
What if I delay treatment?
- HIV will continue to harm your immune system.
- This will put you at higher risk for developing AIDS. Learn more about AIDS and opportunistic infections.
- This will put you at higher risk for transmitting HIV to your sexual and injection partners.
What are the benefits of taking my HIV medicine every day as prescribed?
What Is Hiv Treatment
HIV treatment involves taking medicines that slow the progression of the virus in your body. HIV is a type of virus called a retrovirus, and the combination of drugs used to treat it is called antiretroviral therapy . ART is recommended for all people living with HIV, regardless of how long theyve had the virus or how healthy they are. ART must be taken every day, exactly as your health care provider prescribes.
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Reasons Why Hiv Has Been Such A Difficult Medical Challenge
However, to comprehend the reasoning, you must first familiarize yourself with how HIV works. HIV is a retrovirus, meaning that once it enters the body it infects T cells in the immune system and changes their genetic makeup, so that rather than protect the body as they are meant to, they now create more HIV. This eventually kills the body’s T cells in the process. Once a patients T cell count drops to a certain number, he is considered as having AIDS. At this point, his immune system is no longer able to protect him against otherwise harmless infections and viruses. Anti-retroviral are given to HIV patients to help them live longer, but the patient still remains HIV-positive. This is because eliminating the virus completely is something scientists have not figured out how to do yet.