There are around 2.6 million children and adolescents globally living with HIV, mostly in Africa. These young individuals face a higher risk of treatment failure compared to adults. Experts previously believed that testing for viral drug resistance could enhance treatment outcomes for those failing treatment. However, a recent study led by the University of Basel, Switzerland, emphasizes the importance of supporting patients in consistently taking their medication.
Efforts against HIV have advanced significantly in recent decades. Antiretroviral drugs effectively suppress the virus, preventing its replication and transmission. Yet, some strains have developed resistance to these drugs. In wealthier nations, doctors test for viral mutations when antiretroviral therapy is ineffective.
In regions with limited resources, such tests are less accessible. If treatment fails, physicians may need to switch medications based on guesswork. To avoid potential viral resistance, altering the medication is suggested. However, if the failure is due to inconsistent medication intake, the treatment should not be changed.
In light of financial constraints on HIV programs in African nations, experts debate whether more resistance tests, especially for children and adolescents, could improve treatment outcomes.
Professor Niklaus Labhardt and an international team, in collaboration with various partners, investigated the effectiveness of these expensive tests on HIV management. Their study, “GIVE MOVE,” is published in The Lancet Global Health.
Limited Impact of Resistance Tests alone
The research involved 284 participants aged six months to 19 years across clinical centers in Lesotho and Tanzania. They were all on antiretroviral therapy but had high HIV viral loads.
The patients were randomly split into two groups – one underwent viral mutation tests for resistance, while the second received standard care with viral load monitoring and standard treatment.
The findings revealed no significant treatment improvement from genetic resistance testing. After 36 weeks, both groups showed similar viral loads. Dr. Jennifer Brown, the study’s lead author, notes that relying on resistance tests did not notably impact clinical outcomes.
Adherence to Medication is Key
The primary reason for high viral loads despite medication use seems to be inconsistent daily intake. Study lead Niklaus Labhardt emphasizes that enhancing treatment adherence is more effective than widespread resistance testing. This insight is vital for allocating limited HIV program resources.
The researchers anticipate that these findings will lead to increased support for programs catering to the unique needs of children and adolescents, thus promoting better treatment adherence. Additionally, identifying individuals at higher risk of viral resistance may optimize targeted and cost-effective resistance testing.
The study involved collaborations with various institutions and was funded by three foundations: Fondation Botnar, the Swiss National Science Foundation, and the Gottfried und Julia Bangerter-Rhyner-Stiftung.
