The international AIDS conference to be held in Amsterdam on July 23-27 of this year is expected to be the largest conference of its kind in the world. But along with hearing about new initiatives in HIV prevention and the real success of prevention and treatment programs to date, delegates will also be learning about a new and frightening danger only beginning to receive serious attention: HIV drug resistance.
While the rise of antibiotic resistant strains of most diseases thought to be virtually eradicated up to now has alarmed medical professionals worldwide, the spectacular success of programs aimed at making HIV/AIDS into a manageable disease has led to a false sense of security, at least in developed nations where anti-retroviral drugs (ARVs) are easily obtained.
The massive rollout of ARVs in recent years has certainly saved millions of lives and allowed countless others to live symptom-free at the cost of less than a dollar a day in most cases. Since 2003, HIV/AIDS deaths have declined by 40 percent worldwide and most countries in sub-Saharan Africa are reporting declines in the 25 to 50 percent range.
But HIV continues to be the fastest mutating disease organism on the planet. As a zoonotic virus (an animal virus that has jumped to humans), it has a mutation rate more than a million times greater than bacteria. And when two different HIV strains infect the same cell, it provides an opportunity for these different RNA strands to merge and create new recombinant viruses. This skyrocketing genetic diversity allows for the rapid development of drug resistance in the multiple HIV strains currently infecting humans .
This problem is also compounded by the difficulty providing an effective drug cocktail regimen in many developing nations where drugs are harder to obtain. Though there are 28 different anti-retroviral drugs approved for human use in the United States alone, most of these aren't available in other parts of the world and patients who become resistant to those few available treatments often end up dying as their symptoms become terminal. Also, the economic costs of ARV treatment often mean that patients may not take the full recommended regimen providing a greater opportunity for drug resistance to develop.
In a bleak report released in June, 2017, the World Health Organization (WHO) indicated that 30 percent of people with HIV failed ARV treatment after one year in countries such as Cameroon. Cases of acquired drug resistance are being increasingly reported in Africa, Asia, and Latin America. Also, while this disturbing rise in drug resistance seems largely restricted to developing nations, at least for now, the rise in new cases will almost certainly spread to developed nations as they did during the first wave of AIDS deaths.
As health experts warn, it is far too soon to assume the war against HIV/AIDS is over, especially with these new challenges being faced. How we deal with this new epidemic in the making may be our most crucial test yet.