Health

HIV drug resistance: World Antimicrobial Awareness Week 2020

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Key definitions

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Antimicrobial resistance happens when microorganisms resist the consequences of medicines, making infections tougher to deal with and rising the danger of illness unfold, extreme sickness and demise. Combatting antimicrobial resistance is a world
precedence that wants coordinated motion throughout all authorities sectors and ranges of society.

HIV drug resistance is attributable to modifications within the genetic construction of HIV that impacts the power of medicine to dam the replication of the virus. Minimizing the emergence and transmission of HIV drug resistance is a crucial a part of world
efforts to handle antimicrobial resistance.

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Division info observe

Over the previous decade, the world has witnessed unprecedented scale-up of antiretroviral remedy (ART), which has saved the lives of tens of hundreds of thousands of individuals. As of December 2019, 25.4 million individuals out of an estimated 38 million individuals residing with HIV
had been receiving ART globally. An elevated use of HIV medicines has been accompanied by the emergence of HIV drug resistance, which has additionally steadily elevated in recent times. 

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If not prevented, resistance can jeopardize the efficacy of antiretroviral medication, as proven by a newly printed systematic review and meta-analysis. Resistance
can also be related to an elevated variety of HIV infections and HIV-associated instances and deaths.

To coordinate the worldwide effort to guard the long-term efficacy of HIV medicines, WHO, in collaboration with HIVResNet, a world HIV resistance community, developed an HIV drug resistance prevention and assessment strategy. The technique gives an outline of WHO-recommended
actions on the nation degree to fight pointless emergence and transmission of drug-resistant HIV.

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The 2020 up to date HIV drug resistance technique – which is to be launched earlier than the top of the yr – considers classes realized within the subject over the past decade and anticipates the continuing scale-up of antiretroviral remedy and HIV pre-exposure
prophylaxis in low- and middle-income nations throughout an period of transition to dolutegravir-based regimens.

The muse of WHO’s advice is the event, by nations, of a 5-year nationwide motion plan on HIV drug resistance, which is aligned with the 5 key pillars of the Global action plan on HIV drug resistance:

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  1. prevention and response,
  2. monitoring and surveillance,
  3. analysis and innovation,
  4. laboratory capability, and
  5. governance and enabling mechanisms.

The World HIV Drug Resistance World Motion plan mirrors and is interlinked with the Global action plan on antimicrobial resistance.  

Standardized surveillance of HIV drug resistance gives nations with actionable proof that’s used to optimize affected person and population-level therapy outcomes. The surveillance of pretreatment HIV drug resistance (drug resistance current within the virus of individuals beginning or re-starting antiretroviral remedy) informs the nationwide selection of really helpful first-line antiretroviral regimens. WHO has developed survey strategies to observe pretreatment HIV drug resistance
amongst adults and
infants.  

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The surveillance of drug-resistant HIV in individuals taking antiretroviral remedy (so-called acquired HIV drug resistance) gives essential info to evaluate the efficiency of ART programmes in reaching viral load suppression targets and estimates
the prevalence and patterns of resistance in populations receiving therapy for HIV. WHO survey strategies for acquired HIV drug resistance might be up to date earlier than the top of the yr, to mirror the expanded entry of viral load testing and the
reality {that a} world transition to dolutegravir-based antiretroviral regimens is underway in most nations. This new strategy will present nations with sturdy estimates of acquired dolutegravir resistance, which may be monitored over time. 

WHO has simply launched the steerage on HIV drug resistance surveillance in countries scaling up pre-exposure prophylaxis (PrEP).
Whereas it’s universally anticipated that HIV an infection might be an rare occasion amongst populations taking pre-exposure prophylaxis to forestall HIV an infection, drug-resistant HIV can emerge within the very small quantity of people that could turn out to be contaminated whereas
taking PrEP. This will negatively influence the effectiveness of obtainable antiretroviral therapy choices on account of using the identical medication for each prevention and as parts of really helpful first-line antiretroviral remedy.

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International locations implementing HIV drug resistance surveys are inspired to carry out HIV drug resistance testing at laboratories designated by WHO for the aim of performing HIV drug resistance testing for surveillance.

Map: WHO HIV drug resistance laboratory community

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These laboratories are members of the WHO HIVResNet and performance underneath the WHO HIV drug resistance Laboratory Operational Framework.
This second version, simply printed in 2020, displays current technical and strategic developments, together with consideration of next-generation sequencing strategies, updates to plain working procedures and high quality assurance of HIV sequences
such because the integrase gene and assay validation suggestions. The really helpful specimen varieties for HIV drug resistance genotyping are plasma or dried blood spots. Dried blood spots ought to be used for HIV drug resistance surveys wherein plasma can not
be dealt with as per WHO suggestions. The WHO manual for HIV drug resistance testing using dried blood spot specimens,
third version  simply printed in 2020, emphasises finest practices for dried blood spots preparation, storage and delivery, in addition to collection of acceptable optimistic controls. 

WHO’s HIV drug resistance report 2019 confirmed substantial progress within the surveillance of HIV drug resistance. Between 2004 and 2020, 57 nations applied surveys of HIV drug resistance utilizing WHO-recommended strategies (see map under), and 17 nations have plans to conduct surveys. International locations
are strongly inspired and supported of their efforts to promptly interpret, disseminate and use HIV drug resistance survey knowledge at nationwide and world ranges to tell therapy coverage selections and to advocate for sturdy HIVDR prevention and response
efforts.

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Map of nations implementing nationwide HIV drug resistance surveys, 2004–2020

Implementation of national HIV drug resistance surveys, 2004–2020

 


Webinar 

Be part of  us for a webinar on “Addressing HIV drug resistance to protect the effectiveness of HIV treatment in celebration of World Antimicrobial Consciousness Week 2020 on 20 November from 14:00 to fifteen:30 CET (Amsterdam, Berlin, Rome, Stockholm, Vienna time)

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The webinar will cowl WHO’s technique to observe and response to HIV drug resistance, newest world epidemiological knowledge, new surveillance strategies, and most up-to-date knowledge on resistance to new ARV medicines used for HIV therapy and prophylaxis.



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