World Antimicrobial Awareness Week 2020

Key definitions

Antimicrobial resistance occurs when microorganisms resist the effects of drugs, which makes it difficult to treat infections and increases the risk of spreading disease, serious illness, and death. Combating antimicrobial resistance is a global priority that requires coordinated action across all government sectors and levels of society.

Resistance to HIV drugs it is caused by changes in the genetic structure of HIV that affect the ability of drugs to block virus replication. Minimizing the occurrence and transmission of drug resistance by HIV is a vital part of global efforts to address antimicrobial resistance.

Department note

Over the last decade, the world has witnessed an unprecedented increase in antiretroviral therapy (ART), which has saved the lives of tens of millions of people. As of December 2019, 25.4 million people out of about 38 million people living with HIV have received ART globally. The increased use of HIV drugs has been accompanied by the emergence of resistance to HIV drugs, which has also been steadily increasing in recent years.

If not prevented, resistance may compromise the effectiveness of antiretroviral drugs, as shown by the newly published systematic review and meta-analysis. Resistance has also been linked to an increased number of HIV infections and HIV-related cases and deaths.

To coordinate global efforts to protect the long-term efficacy of HIV drugs, the WHO, in collaboration with HIVResNet, the global HIV resistance network, has developed Strategy for prevention and assessment of resistance to HIV drugs. The strategy provides an overview of the actions recommended by the WHO at the national level in combating the unnecessary occurrence and transmission of drug-resistant HIV.

The updated drug resistance strategy for 2020, to be published before the end of the year, takes into account lessons learned in the field over the last decade and envisions a continuous expansion of antiretroviral therapy and HIV prevention before exposure in low- and middle-income countries during the transition era. dolutegravir-based regimens.

The basis of the WHO recommendation is the development of five-year development by countries national action plan for HIV resistance, which is aligned with 5 key pillars Global Action Plan for HIV Resistance:

1. prevention and response,
2. monitoring and supervision,
3. research and innovation,
4. laboratory capacity and
5. management and enabling mechanisms.

The Global HIV Drug Resistance Action Plan is being replicated and linked to Global Antimicrobial Resistance Action Plan.

Standardized monitoring drug resistance to HIV provides countries with effective evidence used to optimize treatment outcomes at the patient and population level. Control over pretreatment HIV drug resistance (drug resistance present in the virus in people starting or restarting antiretroviral therapy) inform about the national choice of recommended first-line antiretroviral regimens. The WHO has developed survey methods to monitor resistance to HIV drugs before adults and
infants.

The WHO has just published guidelines on Surveillance of HIV drug resistance in countries increasing pre-exposure prophylaxis (PrEP). Although HIV infection is universally expected to be a rare occurrence among populations taking pre-exposure prophylaxis to prevent HIV infection, drug-resistant HIV may occur in a very small number of people who can become infected while taking PrEP . This may adversely affect the efficacy of available antiretroviral treatment options due to the use of the same drugs both for prevention and as part of the recommended first-line antiretroviral therapy.

Countries conducting HIV drug resistance surveys are encouraged to conduct HIV drug resistance testing in WHO-designated laboratories for the purpose of conducting HIV drug resistance testing for surveillance.

Map: WHO HIV Drug Resistance Laboratory Network

These laboratories are members of WHO HIVResNet and operate within Operational framework of the WHO HIV Drug Resistance Laboratory. This second edition, just released in 2020, reflects recent technical and strategic developments, including a review of next-generation sequencing methods, updates to standard operating procedures, and quality assurance of HIV sequences such as gene integration and test validation recommendations. The recommended types of samples for genotyping HIV resistance are plasma or dried blood stains. Dried blood stains should be used for resistance testing to HIV drugs in which plasma cannot be handled according to WHO recommendations. The WHO Manual for HIV Drug Resistance Testing Using Dried Blood Spot Samples, the third edition just released in 2020, highlights best practices for preparing, storing and shipping dried blood stains, as well as selecting appropriate positive controls.

WHO HIV Drug Resistance Report 2019 has shown significant progress in controlling HIV drug resistance. Between 2004 and 2020, 57 countries conducted research on drug resistance to HIV methods recommended by the WHO (see map below), and 17 countries plan to conduct research. Countries are strongly encouraged and supported in their efforts to rapidly interpret, disseminate and use data from the HIV Drug Response Survey nationally and globally to inform treatment policy choices and advocate for strong efforts to prevent and respond to HIVDR.

Map of countries conducting national research on drug resistance to HIV, 2004-2020

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Webinar

Join us for a webinar on “Addressing the problem of resistance to HIV drugs to protect the effectiveness of HIV treatment in celebration of World Antimicrobial Awareness Week 2020 20 November from 14:00 to 15:30 CET (Amsterdam, Berlin, Rome, Stockholm, Vienna time)

The webinar will cover the WHO strategy for monitoring and responding to HIV drug resistance, the latest global epidemiological data, new surveillance methods and the latest data on resistance to new ARV drugs used to treat and prevent HIV.