WHO - HIV DRUG RESISTANCE REPORT 2021
Antiretroviral therapy (ART) has been scaled up at an unprecedented rate over the past decade: at the end of December 2020, 27.5 million people were receiving ART globally. As efforts to scale up ART and pre-exposure prophylaxis (PrEP) continue, and more individuals receive antiretroviral (ARV) drugs for treating and preventing HIV, a further increase in HIV drug resistance is likely.
Drug-resistant HIV is selected when the virus replicates in the presence of subtherapeutic levels of ARV drugs. HIV drug resistance can compromise the effectiveness of HIV treatments, leading to possible increase in HIV incidence and HIV-associated morbidity and mortality.
In 2017, WHO launched a comprehensive global action plan to prevent, monitor and respond to HIV drug resistance at the global and country levels and to protect the ongoing progress towards achieving the global targets for epidemic control by 2030. To minimize the emergence and transmission of drug-resistant HIV, WHO recommends that ART and PrEP programmes be accompanied by measures to monitor the quality of ART and PrEP delivery and by routine surveillance of population-level HIV drug resistance.
Routine surveillance of HIV drug resistance provides countries with evidence that informs national HIV treatment guidelines and that can be leveraged to optimize patient and population-level treatment outcomes. WHO recommends implementing the following nationally representative HIV drug resistance surveys:
• surveillance of acquired HIV drug resistance in adults, children and adolescents receiving ART;
• surveillance of pretreatment HIV drug resistance among treatment-naive infants newly diagnosed with HIV;
• surveillance of pretreatment HIV drug resistance among adults initiating or reinitiating first-line ART and
• surveillance of HIV drug resistance among individuals using pre-exposure prophylaxis who are diagnosed with HIV
The 2021 HIV drug resistance report summarizes the progress in the implementation and the outcomes of the WHO-recommended surveys ( Sections 1, 2 and 4). The report includes a literature review on HIV drug resistance among populations receiving PrEP who are diagnosed with HIV, which foreshadows the need for surveillance of resistance among people taking PrEP who test positive for HIV ( Section 3). Finally, this report summarizes theprogress achieved between 2017 and 2020 in implementing the Global Action Plan on HIV drug resistance 2017-2021 and summarizes the remaining challenges, with specific focus on 45 countries accounting for more than 85% of thetotal burden of HIV infection ( Section 5).