For the first time, a country-wide survey to assess drug resistance against HIV will be undertaken by the Pune-based National AIDS Research Institute (NARI) in the next few months.The survey will also be funded by the National AIDS Control Organisation (NACO), and it will be undertaken at 52 anti-retroviral treatment (ART) centres across the country. A recent HIV drug resistance report by the World Health Organisation (WHO) shows that in six of the 11 countries surveyed in Africa, Asia and Latin America, over 10 per cent of people starting anti-retroviral therapy had a strain of HIV that was resistant to some of the most widely used HIV medicines. While the report paints a worrying picture about increasing levels of drug resistance, NACO officials said such levels were low in India. In India, 21 lakh people live with HIV and as many as 10.75 lakh people are on anti-retroviral treatment. According to NACO officials, 25,000 persons were on the second line regimen of drugs, after first line treatment had failed, while 450 had grown resistant to the second line treatment and were now on the third line treatment regimen of drugs.
In the last decade, successful implementation of the National AIDS Control Programme has contributed to a decline in the estimated adult HIV prevalence, which has dropped from 0.34 per cent in 2007 to 0.26 per cent in 2015. The free antiretroviral therapy (ART) programme has also been scaled up considerably, from eight ART centres in 2004 to 536 across the country. With this rapid rollout of ART, the emergence of drug resistance is inevitable, said NACO officials. NARI Director Dr R R Gangakhedkar told The Indian Express that HIV drug resistance often develops when people don’t adhere to a prescribed treatment plan, and also when they don’t have consistent access to quality HIV treatment and care.
As per new guidelines, any person who is detected with HIV can avail of free anti-retroviral drugs and there are plans underway to bring in viral load testing to monitor the patients, said NACO officials. Dr Gangakhedkar pointed out results of a new study published in PloS One, in which researchers reported the drug resistance outcomes in individuals for whom the first-line of anti-retroviral treatment has failed. “The decade-old National AIDS Control Programme still relies on immunological monitoring (when CD 4 cell counts are measured every six months). However, Plasma Viral Load testing is reserved only to confirm the failure of first line ART… we found that close to 40 per cent patients….had developed three drug resistant mutations,” said Gangakhedkar. The success of high-quality ART depends on timely monitoring of viral load and confirmation of ART failure.