Drug resistance: Understanding HIV/AIDS

A medic in the labarotory. Testing for HIV drug resistance is important. /Courtesy

The Ministry of Health is planning to conduct the Rwanda Population HIV Impact Assessment (RPHIA) survey, with the aim of getting fresh numbers on HIV/AIDS and Hepatitis C in Rwanda.

The survey will be conducted by the Ministry of Health in partnership with ICAP, a Colombian company which supports programmes and research that address HIV/AIDS and related conditions, and works to strengthen health systems in 29 countries across the globe.

According to the Ministry, they are expecting new figures of HIV and AIDS at the provincial and national levels from the research, as well as people with resistant HIV.

They want to have a general image on how people take ARVs and the state of viral load suppression.

HIV RESISTANCE

Boniface Nsekanabo, a medic at AVEGA Clinic in Remera, says as HIV multiplies in the body, the virus sometimes mutates (changes form) and produces variations of itself.

He says that variations of HIV that develop while a person is taking HIV medicines can lead to drug-resistant strains of HIV.

“With drug resistance, HIV medicines that previously controlled a person’s HIV are not effective against new, drug resistant HIV. In other words, the HIV medicines can’t prevent the drug-resistant HIV from multiplying. Drug resistance can cause HIV treatment to fail,” he says.

He adds that a person can initially be infected with drug resistant HIV or develop drug-resistant HIV after starting HIV medicines.

However, Nsekanabo says that the worst thing is that when it comes to drug resistance, drug resistant HIV can spread from person to person.

He explains that people initially infected with drug resistant HIV have drug resistance to one or more HIV medicines, even before they start taking HIV medicines.

WHEN, HOW TO TEST FOR HIV DRUG RESISTANCE

Nsekanabo notes that drug-resistance testing helps identify which, if any, HIV medicines won’t be effective against a person’s HIV.

He says that drug-resistance testing results help determine which HIV medicines to include in an HIV treatment regimen.

“Physicians should be in a position to do drug-resistance testing in order to identify which, if any, HIV medicines won’t be effective against a person’s strain of HIV; and this is done using a sample of blood,” he says.

However, he notes that this (drug resistance testing) should happen when a person first begins receiving care for HIV infection.

“Resistance testing should be done, whether the person decides to start taking HIV medicines immediately, or delays treatment. If treatment is delayed, resistance testing may be repeated when HIV medicines are started,” he says.

Dr Jean Baptiste Habumuremyi, head of Gatanga Health Centre, Kicukiro, says this can as well be done before a person starts HIV treatment, and the first time can show whether the person was initially infected with a drug-resistant strain of HIV.

Habumuremyi notes that these drug-resistance testing results are the ones used to decide which HIV medicines to include in a person’s first HIV regimen.

He explains that after treatment is started, drug-resistance testing is repeated, especially if viral load testing indicates that a person’s HIV regimen isn’t controlling the virus.

He adds that if drug-resistance testing shows that the HIV regimen isn’t effective because of drug resistance, then the test results can be used to select a new HIV regimen.

John Muganda, a gynaecologist at Harmony Clinic in Kigali, says when it comes to pregnant women with HIV, it’s a must for them to do drug-resistance testing. 

He says normally, this is done before one starts HIV medicines and also in some pregnant women already taking HIV medicines.

Muganda, however, advices that pregnant women with HIV should ensure that they work closely with their gynaecologists in order to decide if drug-resistance testing is needed at any point.

WHY ADHERING TO MEDICATION IS VITAL

Patricia Gasasira, a nurse working at Clinic Galien Clinic, Gasabo, says people who are HIV positive need to understand that the only way to remain healthy and continue living is by following the recommendation given by their physicians on how to take their medicines.

She notes that when it comes to medication adherence, it means that one has to take HIV medicines every day and exactly as prescribed. 

“HIV medicines prevent HIV from multiplying, so skipping these medicines allows HIV to multiply, which increases the risk of the virus to mutate and produce drug-resistant HIV,” he says.

As a result of drug resistance, she says, one or more HIV medicines in a person’s HIV regimen may no longer be effective.

She adds that to stay adhered to medications, a person has to take HIV medicines every single day and exactly as prescribed, which is the only way of reducing the risk of drug resistance.

RESISTANCE TO OTHER MEDICINES

Francis Kazungu, a general practitioner in Kigali, says when it comes to HIV treatment; there are different HIV drug classes.

He says there is something called cross resistance and explains that this is when resistance to one HIV medicine causes resistance to other medicines in the same HIV drug class.

He explains that HIV medicines are grouped into drug classes according to how they fight HIV, and as a result of cross resistance, a person’s HIV may be resistant even to HIV medicines that the person has never taken.

“Cross resistance limits the number of HIV medicines available to include in an HIV regimen,” Kazungu says.

HOW TO REDUCE RISK OF DRUG RESISTANCE

Habumuremyi says the only way to achieve this is by adhering to an effective HIV treatment regimen; which reduces the risk of drug resistance.

He says that there are ways one can adopt to achieve all this.

“It’s important for an HIV infected person to work closely with their physician, once they start treatment,” he says.

This, Habumuremyi says, helps them (physician) to choose an HIV regimen that suits ones needs. Adding that a regimen that meets ones needs always make adherence easier. 

Gasasira says that the patient should be able to open up to the health expert and tell them about any issues that could make adherence difficult.

This information, she says, is vital because it helps the health provider find ways to help a patient, which in the long run ensures that one is able to respect the schedule.

She says that patients should keep their medical appointments so that healthcare providers can monitor their HIV treatment, which makes the whole process easier.

Appointments are a good time to ask questions and ask for help to manage problems that make it hard to follow an HIV regimen.

“It’s during these appointments that a patient can make inquiries on when they feel there is a concern. It helps rectify or point out a problem, thus making it easier for medication as far as HIV treatment is concerned,” she says.

Experts share their views

If one is taking antiretroviral drugs, it is important to eat a healthy, balanced diet, as HIV medication can cause changes in the way the body processes some fats and sugars.

 

Patricia Gasasira, Nurse

 

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People should stay away from sexually-transmitted diseases including HIV by avoiding un-protected sex. Also, going for testing for HIV at least every three months is vital.

 

Dr Jean Damascene Makuza, STI care and treatment senior officer at RBC

 

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Maintaining good nutrition is vital for everyone’s health. In fact, nutrition plays an important role in the health of the immune system and its ability to fight infections, and this applies to those with HIV as well.

 

Private Kamanzi, Nutritionist

 

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Expectant mothers should always test for HIV, if positive, they are followed up and this gives them a chance to give birth to a healthy baby. Treatment helps to reduce the strength of the virus as well.

 

Dr Gonzalue Niyigaba,

Medic at CHUK

 

editorial@newtimes.co.rw

 

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