The World Health Organization (WHO) published new guidelines for managing human immunodeficiency virus drug resistance (HIVDR) in countries in which pretreatment HIVDR to non-nucleoside reverse transcriptase inhibitors (NNRTIs) is prevalent. The guidelines were presented at the 9th International AIDS Society Conference on HIV Science.1

Pretreatment HIVDR to NNRTIs, such as efavirenz and nevirapine, is increasing worldwide, according to the 2017 WHO report on HIV drug resistance. In eastern Africa, southern Africa, and Latin America, the prevalence of HIVDR is approximately 10% or higher.“Efavirenz and nevirapine are currently a critical component of first-line regimens in low- and middle-income countries and people with drug resistance are at risk for worse outcomes compared to those without drug resistance. Specifically, those with drug-resistant virus already present before they start first-line [antiretroviral therapy] are less likely to achieve and maintain virological suppression, more likely to stop treatment, and more likely to acquire more drug resistance mutations,” Silvia Bertagnolio, MD, from the WHO department of HIV and global hepatitis programme, told Infectious Disease Advisor.

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The WHO report also found that in patients initiating first-line antiretroviral therapy (ART), patients with previous exposure to antiretroviral drugs (ARV) are more likely to have pretreatment HIVDR to NNRTIs than patients who are ARV-naïve (21.6% vs 9.3%; P<.0001). People with previous exposure to ARVs may include women who were treated with ARVs as part of the prevention of mother-to-child transmission (PMTCT) or individuals who have discontinued a prior ART regimen.2

The issue of pretreatment HIVDR is further complicated by the fact that low- and middle-income countries do not have ready access to testing for HIVDR. As a result, patients with HIVDR may go undetected and receive treatment with NNRTI regimens that are only partially effective, further exacerbating transmission of HIV and drug-resistant HIV.1

“Over the next 5 years, millions more people need to start ART and be maintained on it for life; therefore, to maximize achieving the end of AIDS as a public health threat, guidelines indicating ‘what to do’ in countries observing high levels of HIVDR were necessary,” Dr Bertagnolio said.

This article originally appeared on Infectious Disease Advisor