January 4, 2010
Ten years ago, drug-resistant HIV affected 1-5 percent of HIV/AIDS patients worldwide. In Sub-Saharan Africa, where few patients had access to antiretrovirals (ARVs) a decade ago, resistance rates have climbed to about 5 percent in the past few years. Since many physicians and clinics do not track resistance, the proportion could be even higher.
The UN's estimate of $25 billion needed to fight AIDS in 2010 does not account for treating resistant strains, which could push the sum up to $44 billion. Donors will probably come up with only half of the lower sum, nevertheless.
"For the first two or three years I was not seeing it. It was rare," said Dr. Theresa Rossouw of the Tshwane District Hospital's HIV clinic, which treats 5,000 patients. "Now it is really daily. I think in the next five years, we are going to have such a need."
In Rossouw's black binder is a list of 200 patients failing at least one round of therapy. The early generation AIDS drugs distributed in Africa are very unforgiving of non-adherence, systemic interruptions or incorrect prescription. Some of the drugs can be toxic to certain patients. Only a handful of ARVs are available, and once those fail most patients have no other options.
Some of the worst cases of resistance are seen in the hospital's pediatric unit. Rossouw and colleagues explain that they must rely on others to make sure kids take their medicines. Sometimes, AIDS orphans the children, who then wind up juggled among relatives. Young siblings might have oversight of their care or be responsible for diluting the ARVs to pediatric dosages.
"What if they start spreading that resistance in the community?" asks Rossouw, who blames private practices for some of the resistant cases she sees. Many fail to monitor viral loads or treatment adherence, she said. "They just start them on treatment and hope it's going to solve all of their problems."