The World Health Organisation has raised serious concerns that HIV medication shortages sparked by cuts to USAID will increase drug resistance to crucial treatment, The Independent can reveal.
Leading epidemiologists have raised fears that shortages could reduce the effectiveness of the most commonly used HIV drug, dolutegravir (DTG), which is used by around 27 million people. This could leave patients without an alternative treatment.
Professor Andrew Phillips at UCL, who has created a model predicting resistance in HIV patients to DTG, said the number of people currently resistant to the drug could “easily at least double in six months” if people take less than one pill per day due to supply fears.
“If resistance starts to grow, this is a substantial problem for long-term HIV control in lower and middle-income countries,” Prof Phillips said. “If there is a new reality for another year that people are taking less than 70 per cent of their doses, then it would start to feel like a real concern for building up resistance.”
A World Health Organisation spokesperson told this publication it “remains very concerned that we will not have a suitable replacement option for dolutegravir that is as easy to take, with low side effects, delivered at low cost, and safe for all, including children & pregnant women”.
“We should be doing all that we can to protect this first-line treatment and to ensure that the worst-case scenario of increased drug resistance projected by this UCL modelling exercise does not occur.”
It added that DTG-based treatment is intended to be taken daily, so “intermittent use of DTG-based anti-retroviral treatment due to drug shortages is likely to lead to increased drug resistance, and we worry about this scenario.”
The warning comes after The Independent revealed the impact that sudden pauses by the Trump administration on the US President’s Emergency Plan for Aids Relief (PEPFAR) are having on the ground, with patients in countries across sub-Saharan Africa running out of medication.
On Trump’s first day in office, he froze almost all US foreign assistance funds for 90 days, while projects were reviewed to make sure they were aligned with “American interests”.
Aids-related deaths could jump by four million to 10 million by 2030 unless US foreign aid money is reinstated, according to forecasts from the UN Aids agency (UNAIDS).
The Independent recently travelled to Uganda and Zimbabwe to see the impact of severing aid to those suffering from HIV. Among them was Hadja, who was pregnant and terrified that she would not be able to protect her unborn child. She described visiting hospitals where neither doctors or drugs were available.
James, a 50-year-old father of four, is also HIV positive and has not had access to HIV medication for over a month and a half. Without antiretroviral drugs, James’s emaciated body is shutting down.
The US government is expected to review its decision to stop PEPFAR, but there has been no indication that funding will resume.
UNAIDS deputy executive director, Angeli Achrekar, told The Independent that drug shortages on the ground are “a recipe for disaster” in terms of increased drug resistance.
She said: “When we have drug resistance to the medication that people are on, they have to be put on second- or third-line therapy, which is much more expensive and much more difficult to access. Coupled with all these new infections, that is a recipe for disaster.”
Dolutegravir (DTG) is currently the first- and second-line treatment for HIV, with 90 per cent of the 30 million people living with HIV on a treatment regimen that includes this drug. Currently, resistance to DTG is low, at around 4 per cent, but for groups of patients who have already become resistant to previous antiretroviral regimes, prevalence jumps to 19 per cent.
Professor Brooke Nichols, an infectious disease mathematical modeller and health economist, told The Independent: “If you have tens of thousands of people thinking they need to ration and take treatment intermittently, and you don’t keep the virus fully suppressed, then when the virus rebounds, it could mutate and develop resistance to whatever drug is circulating,” she said.
“That is the really scary tipping point for resistance.”
Anyone who develops multi-drug-resistant strains of HIV may need second- or third-line treatment, which costs at least $405 (£305) in lower-income countries: a sixfold increase on the cost of first-line antiretrovirals.
Jeffrey Eaton, senior research fellow in HIV Epidemiology at Imperial College London, also warned that if people become resistant to an HIV medication, “they could transmit that resistance and then newly infected people might not be able to use dolutegravir.”
Clinicians in the worst-hit areas have also told The Independent they’re seeing worrying interruptions in HIV antiretroviral drug supplies.
One clinic, the Family Hope Centre in southern Uganda — a country where 70 per cent of the HIV/Aids response was funded by PEPFAR – had to close for a month recently because, without foreign aid, it was unable to afford the rent, water and electricity bills.
Irene Anamu, the Family Hope Centre’s administrative director, told The Independent the centre has already seen a rise in clients contracting infections, including tuberculosis.
She is now worried that the gaps in treatment will allow the virus in patients’ bodies to replicate, “meaning more drug-resistant clients”, and strains which could spread past Uganda borders.
A US State Department spokesperson said: “As directed by the Secretary of State, urgent life-saving HIV care and treatment and prevention of mother-to-child transmission services are ongoing. As part of the overall foreign assistance review, all PEPFAR-funded services are currently being reviewed for assessment of programmatic efficiencies and consistency with United States foreign policy.”
This article is part of The Independent’s Rethinking Global Aid project
