WHO warns of growing resistance to first-line HIV drug

Resistance to a widely used HIV drug is growing among patients, the World Health Organization (WHO) has warned, sparking concern among scientists.

Dolutegravir has been recommended by the WHO as the preferred first-line treatment for HIV since 2018 and is currently used by more than 24 million patients worldwide.

However, it now appears the effectiveness of the medication is beginning to wane in users as the HIV virus grows resistant to the drug, according to a new report published by the WHO. 

Dolutegravir is an antiretroviral medicine and is used in combination with other drugs to reduce the amount of virus in the body to an undetectable level. Although not a cure, it is effective in preventing the development of serious illness, as well as further transmission.

However, like other viruses, bacteria, and fungi, HIV has genetically adapted over time to circumvent the drugs used to treat it – meaning that, in some patients, the drug becomes either partially or completely ineffective, increasing the risk of disease and death. 

Ravindra Gupta, Professor of Clinical Microbiology at the University of Cambridge, said the WHO’s findings were “concerning”. 

“It’s a call to action to strengthen surveillance in order to preserve the utility of the drug,” he said.

“Dolutegravir is very potent and effective, and so it was expected that there would be little to no resistance when it was first introduced.”

‘Worrying’ data

The WHO conducted research in Malawi, Mozambique, Ukraine, and Uganda, and found that resistance to dolutegravir ranged from around four to 20 per cent among patients surveyed. 

The data is “worrying evidence” that drug resistance is “growing,” the organisation said. 

The WHO said that routine surveillance of HIV mutations in patients receiving antiviral therapy is needed to help understand the patterns of resistance.

Currently, only 12 of the 45 countries identified by the WHO as HIV prevalent have reported routine monitoring of drug resistance. 

“We agree with the WHO that there is a need for further surveillance,” said a spokesperson from British pharmaceutical company GSK, which manufactures the drug.

“The resistance analysis focuses on subgroups whose virus was not suppressed and the data does not indicate that resistance was prevalent in the overall population,” the spokesperson added, however. 

Dolutegravir is more effective, easier to take and has fewer side effects than other HIV drugs currently in use. It also has a high genetic barrier to developing drug resistance.

According to the WHO, drug resistance kills 4.9 million every year globally, and it’s estimated this number will rise to 10 million by 2050 as viruses, bacteria and other pathogens further evolve to evade modern medicine.

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