Study finds high levels of drug resistance among Ethiopian children failing HIV treatment

published on March 27, 2018

BC Centre for Excellence in HIV/AIDS testing discovers there are no remaining options for one-third of Ethiopian children who fail their first-line regimen

(VANCOUVER, March 27, 2018) New research from BC Centre for Excellence in HIV/AIDS (BC-CfE), Simon Fraser University (SFU) and Hawassa University in Ethiopia, found high rates HIV of drug resistance in Ethiopian children failing their first-line HIV treatment.

Researchers studied 94 children under the age of 15 who were failing first-line HIV treatment. The study team found 81 per cent of participants harbored some resistance mutations. Roughly two-thirds harbored resistance to drugs that are used in all first-line HIV treatment regimens in children - both Nucleoside Reverse Transcriptase Inhibitors (NRTIs) and Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs). Forty-two per cent of resistant participants (or 30 per cent overall) harbored resistance to all four NRTIs recommended for second-line treatment.

“These results are concerning and show we need further research to determine how widespread the issue is globally and secure a firm commitment to Treatment as Prevention® in every corner of the world to eliminate the threat of HIV/AIDS,” says Dr. Montaner, Director of the BC Centre for Excellence in HIV/AIDS. “In addition to diagnosing people and getting them on treatment to reduce disease progression and transmission, including mother to child transmission, we need to have patients on the most effective treatment right away with adequate follow up and support to maximize the chances of treatment success and prevent the development of HIV drug resistance.”

High levels of drug resistance can arise, limiting future HIV treatment options. Drug resistance mutations were most prevalent in children who had spent a longer period on HIV treatment and switched treatment regimens in the past.

“It is especially worrisome to see drug resistance in children, especially since the progression to AIDS happens faster compared to adults and because pediatric HIV treatment options are generally limited in resource-constrained settings,” says Dr. Zabrina Brumme, BC Centre for Excellence in HIV/AIDS and health sciences professor at SFU. “Worldwide, there are 1.8 million children living with HIV under the age of 15, nearly 1.5 million live in sub-Saharan Africa. We must monitor HIV treatment very closely, especially in children, to prevent the development of drug resistance."

“We urgently need to implement drug resistance tests in our clinics and expand the number of HIV medications available to us in Ethiopia,” says Dr. Birkneh Tilahun Tadesse, Hawassa University. “Progress at the local level, especially in Ethiopia, as in many other resource-limited settings, is crucial to meeting global HIV/AIDS targets.”

The UNAIDS 90-90-90 Target, developed by Dr. Julio Montaner, proposes to have at least 90 per cent of all people living with HIV diagnosed, at least 90 per cent of them on antiretroviral therapy and at least 90 per cent of them virologically suppressed by 2020. Achieving the 90-90-90 Target by 2020 would lead to a 90 per cent reduction in HIV/AIDS morbidity and mortality and a 90 per cent decrease in new HIV infections by 2030.

“There is still time to turn this around. We set the Treatment as Prevention® inspired 90-90-90 Target to spur the global community into action and measure our progress. There is no reason a child should be born with HIV anywhere in the world,” says Montaner.

Study researchers say local healthcare systems in resource-limited countries require global support to develop more robust systems to fully implement TasP®. Upon diagnosis, this includes viral load and drug resistance testing to continually monitor how well the treatment is working for the patient, as well as access to new medications and effective treatment options.

About the British Columbia Centre for Excellence in HIV/AIDS

The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada’s largest HIV/AIDS research, treatment and education facility – nationally and internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. The made-in-BC Treatment as Prevention® strategy (TasP®) pioneered by BC-CfE, and supported by UNAIDS since 2011, inspired the ambitious global target for HIV treatment - known as the 90-90-90 Target - to end AIDS as a pandemic by 2030. The BC-CfE is applying TasP® to therapeutic areas beyond HIV/AIDS, including viral hepatitis and substance use, to promote Targeted Disease Elimination (TDE™) as a means to contribute to healthcare sustainability. The BC-CfE works in close collaboration with key stakeholders, including government, health authorities, health care providers, academics, and the community to decrease the health burden of HIV/AIDS, HCV and substance use across Canada and around the world.

For more information or to arrange interviews contact:

Rena Heer
BC Centre for Excellence in HIV/AIDS
Edelman Vancouver
C: 604-280-2800
rena.heer@edelman.com

Ian Bryce
Communications Associate, University Communications
Simon Fraser University
C: 604.773.8134
Ian_Bryce@sfu.ca

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Treatment as Prevention®

Julio Montaner

BC Centre for Excellence in HIV/AIDS

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Study finds high levels of drug resistance among Ethiopian children failing HIV treatment

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