Poor adherence, absorption problems, and low resistance barriers for some HIV medications are the main factors that contribute to drug resistance in HIV management. The rising prevalence of this resistance is an obstacle to achieving the 90-90-90 target proposed by the United Nations Programme on HIV/AIDS (UNAIDS), in which they attempt to achieve virological suppression in 90 per cent of all persons receiving antiretroviral therapy (ART) to fight the HIV epidemic.
The World Health Organization (WHO) is calling on countries to establish multifaceted plans to prevent further HIV drug resistance. According to the WHO, a comprehensive strategy aimed at controlling and preventing HIV drug resistance should include the following:
- Reduction of HIV transmission rates
- Monitoring and suppressing viral loads in affected patients at the population level
- Providing access to effective treatments supported by robust drug supply chains
- Ensuring that ineffective regimens are promptly changed
- Adhering to established treatment guidelines and recommendations
We speak to Dr. Jehad Abdalla, an American Board-certified Infectious Diseases Specialist who is currently active as a consultant at Al Rahba Hospital in Sheikh Khalifa Medical City in Abu Dhabi and learn more about the current landscape of HIV management and drug resistance. Excerpts from the interview:
Global prevention strategies to reduce transmission rates
There are multiple strategies to reduce the risk of acquiring or transmitting HIV. This includes diagnosing all individuals with HIV as early as possible after infection, treating people with HIV rapidly and effectively to reach sustained viral suppression, and preventing new HIV transmissions by using proven interventions (such as pre-exposure prophylaxis [PrEP], using protection, or abstinence).
All the above interventions are effective at reducing risks. Combining multiple prevention strategies may increase effectiveness, but for any option to work, it must be used accurately and consistently.
One unique approach employed in the UAE is having multiple channels and opportunities for HIV testing, such as during the following processes: visa renewal, prenatal, pre-employment, premarital, pre-elective surgeries, pre-college enrolment, and pre-blood donation.
Antiretroviral therapy and impact on patient care
Currently, there are tens of antiretroviral drugs in use. Using an effective combination of these drugs in therapies turned HIV infection into a chronic disease; with compliant treatment and successful management of the illness, a patient’s HIV viral load may be made undetectable, and their life expectancy may be extended nearly to that of a healthy individual.
The HIV regimens currently implemented are very simple, convenient, and extremely effective.
A single-tablet treatment regimen (also known as fixed-dose combinations), which combines several drugs into one tablet that a patient takes once a day is becoming the regimen of choice. Injectable medication administered every two months are a new and superior option for specific types of patients.
The convenience of newly approved HIV medications allows for increased compliance with treatment, higher rates of sustained HIV viral suppression, more favourable clinical outcomes, and reduced rates of disease transmission.
Dr. Jehad Abdalla
Role of nanotechnology and nanomedicine in HIV management
Nanotechnology is a very promising approach to HIV treatment. It may be beneficial for the delivery of antiretroviral drugs to specific immune cells which are targeted by HIV, as well as delivery of antiretroviral drugs to specific body parts which are used by HIV as a reservoir.
Additionally, nanotechnology-based drug delivery systems have been utilised to achieve prolonged and sustained release of some HIV medications which will certainly improve antiviral treatment.
Key research and development areas for stakeholders
The area which is likely to require significant stakeholder and resource input in HIV management is the development of a full cure — one that allows HIV-impacted people to live fully healthy and medication-free lives.
In consideration of the progress made with COVID-19 vaccines and the development of messenger RNA (mRNA) vaccines, this same approach may likely be essential to pave the way for RNA vaccines for HIV in the future.
Future of HIV therapeutics
Neutralising antibodies is a promising approach to treating HIV; these antibodies will bind directly to the virus, preventing it from entering a cell and accelerating its elimination. Alternatively, these antibodies may bind to an HIV-infected cell, recruiting immune-system components which facilitate the elimination of this infected cell.
Long-acting drugs, either through pills or injections administered every few months, are receiving more attention and would likely be favourable for certain groups of patients.
The monumental advancements in HIV management have changed the HIV disease from a devastating untreatable illness to a chronic disease that may be managed and treated to ensure a higher quality of life for the individual. Although HIV is still uncurable, the advancements in its treatment and management along with their benefits cannot be understated.