HIV treatment can greatly reduce due to less control

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Human Immunodeficiency Virus (HIV) has a major impact on global health, affecting many low- and middle-income countries

When HIV treatment no longer works (therapy failure), this poses a threat to the health of people with HIV, especially in circumstances where there are few resources available. Initiatives to reduce treatment failure, such as stricter cut-off values ​​for HIV suppression, better clinical guidance and better control of HIV treatment can greatly reduce treatment failure. These are the main conclusions of Lucas Hermans of UMC Utrecht in his dissertation that he will defend on November 15, 2022.

The Human Immunodeficiency Virus (HIV) has a major impact on global health, affecting many low- and middle-income countries. Combined antiretroviral therapy (ART) has turned HIV infection from a deadly disease to a treatable chronic disease. However, ART cannot cure HIV infection and the patient must take these drugs for life. During treatment there is a risk that the therapy will no longer work properly and that the number of virus particles in the blood will increase again. This so-called treatment failure can be caused by insufficient adherence to treatment, but can also be caused by the development of resistance of the virus to the medication. Therapy failure is a major threat to the success of large-scale HIV treatment programs in African countries, where the healthcare and laboratory infrastructure needed to detect and address treatment failure in a timely manner is limited. The thesis of Lucas Hermans (Department of Medical Microbiology, UMC Utrecht) aims to contribute to the sustainable effectiveness of HIV treatment by developing new strategies for laboratory control during treatment for sub-Saharan African countries. Most of the research was conducted in South Africa, where about 10-15 percent of residents live with HIV.

Therapy failure
Lucas Hermans’ research shows that although ART is usually effective, the treatment does not always remain successful for various reasons. His research confirms that the risk of treatment failure is not only determined by patient-related factors such as gender and income, but also by characteristics of the virus, in particular by the development of resistance of the virus to ART. It also appears that there is a significant delay between the discovery of treatment failure and the clinical measures to address this problem in routine clinical care.

New strategies for control
In his dissertation, he also explored new strategies for the control of HIV treatment. The results of a large South African study presented in this thesis involving nearly 71,000 people with HIV showed that a stricter definition of treatment success – already used in high-income countries – should also be used in low- and middle-income countries. This is because such a stricter definition allows practitioners to discover treatment failure earlier. Innovative tests that show whether the medication is actually ingested (such as ART blood tests using immunoassays and ART urine tests in the workplace) can also be used to detect sub-optimal adherence and identify individuals at risk of being carriers of the drug. HIV variants that are resistant to ART.

Recommendations
Based on the results of his research, Lucas Hermans presents three recommendations for the control of HIV therapy in resource-limited settings:

  1. A stricter cut-off value for the definition of virological suppression should be used worldwide, including in low and middle income countries, as this may contribute to earlier detection of low levels of virus in the blood, which are associated with a higher risk of treatment failure.
  2. Therapy failure is a threat to the health of people with HIV. In many African countries there is a delay between demonstrating treatment failure and taking adequate clinical measures. In case of treatment failure, clinical follow-up steps need to be taken more quickly to maintain the sustainable success of ART.
  3. Innovative technology can be used to improve surveillance of HIV therapy in African countries. Detection tests for ART can detect insufficient adherence and help health professionals identify individuals at high risk of developing resistance.

North-South cooperation
The Translational Virology Research Group at UMC Utrecht focuses on challenges in HIV management such as improving HIV care and the complex quest for a real cure. Under the umbrella of the ITREMA project, supported by ZonMw/WOTRO, the group has set up a research collaboration linking virology, pharmacology, infectious diseases, immunology, public health and social sciences from research centers in the global North and South. This collaboration has resulted in a scientific platform for interdisciplinary research, data sharing and local capacity building. One of the most important results of this collaboration is the scientific work that is now presented in Lucas Hermans’ dissertation.


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Name author and/or edited by:
UMC Utrecht
Photographer or photo agency: :
INGImages
Source for this article: :
UMC Utrecht
What is the URL for this resource?:
https://www.umcutrecht.nl/nieuws/betere-controle-van-hiv-behandeling
Original title:
Better control of HIV treatment
Target audience:
Healthcare Professionals, Students
Datum:
2022-11-10

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