The WHO issued new recommendations to aid national public health programs in addressing pretreatment HIVDR in countries in which HIVDR is highly prevalent. The guidelines are part of the effort to “attain and maintain the treatment target of 90% viral suppression among all people receiving first-line ART by 2020.”1

The guidelines state that non-NNRTI-containing regimens, such as those containing dolutegravir, should be considered as first-line ART in patients with pretreatment HIVDR to NNRTIs.1


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In countries in which testing for HIVDR is not readily available, national public health data on pretreatment HIVDR may be used to guide public health decisions. If no nationally representative data on pretreatment HIVDR are available, efforts to collect such data via surveys should be pursued.1

If the national prevalence of pretreatment HIVDR to NNRTIs is <10%, then the use of non-NNRTI-containing regimens should be prioritized in patients who have previously received treatment with ARVs.1

In countries where the prevalence of pretreatment HIVDR to NNRTIs is ≥10%, the guidelines emphasize urgent consideration of alternative non-NNRTI regimens in all patients initiating first-line ART, regardless of prior ARV exposure history. If alternative regimens cannot be broadly implemented, then introducing pretreatment HIVDR should be considered.1

“Regardless of population-levels of HIVDR, clinicians should focus on prevention of HIVDR by doing all they can to maximize adherence to and retention on ART; support drug supply continuity; and ensure that viral load testing is consistently done in all people on ART, and that these test results are used to identify individuals failing first-line therapy who should be promptly switched to second-line ART regimens,” Dr Bertagnolio said.

References

  1. Guidelines on the public health response to pretreatment HIV drug resistance, July 2017. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. http://apps.who.int/iris/bitstream/10665/255880/1/9789241550055-eng.pdf. Accessed July 27, 2017.
  2. HIV Drug Resistance Report 2017. Geneva: World Health Organization; 2017. www.who.int/hiv/pub/drugresistance/hivdr-report-2017/en/. Accessed July 27, 2017.

This article originally appeared on Infectious Disease Advisor