New HIV drug is not more effective in dealing with resistance than old drugs

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  • Fourteen percent of people tested had drug resistance to Dolutegravir
  • There is no significant difference between the new and old HIV drugs in potential viral suppression
  • Health workers should continue to monitor viral loads even with the new regimen 

A new study has found that Dolutegravir, the three-in-one HIV pill, is not more effective in reducing the chances of resistance than other HIV first-line antiretroviral therapies.

The study was published in the Nature Communications by an international team as part of the ADVANCE study that was conducted in South Africa.

About 1 053 newly HIV diagnosed people participated in the study. Of the participants, 991 provided blood samples for testing pretreatment drug resistance. Researchers found that 14% of those sampled had pretreatment drug resistance. The study compared Dolutegravir to the old HIV drug efavirenz. The research showed that there was not a significant difference in pretreatment drug resistance outcomes.

A new drug comes on board

Dolutegravir or DTG is the most recommended HIV treatment drug because it has very few side effects and for its ability to reduce the chances of people developing drug resistance. South Africa began its rollout of DTG last December. 

But lead author Dr Mark Siedner, infectious diseases specialist and clinical epidemiologist at Africa Health Research Institute (AHRI), tells Health24 that this study shows that even with DTG’s high resistance, there is still a threat to HIV drug-resistant people.

“Last year in South Africa a new drug came on board. There're many positive features of DTG: it's slightly cheaper than efavirenz and it's relatively easy to take. But one of the major benefits of that drug was that it historically has not had a problem with drug resistance.

"And so we thought that it would help to reduce this issue of drug resistance. In this study, we found the opposite,” Sidedner says.    

Siedner says that the research shows that government and healthcare workers cannot relax as drug resistance is still a problem.

A regimen that works

“I think the most important lesson from the study is that we need to remain vigilant, that just because we have a new drug on board and we have reason to be excited about this new drug coming on board, it doesn't mean we can stop monitoring people closely, it doesn't mean we can stop checking people's virus to make sure it's suppressed in their blood, and it doesn't mean we can forget about drug resistance,” he says. 

“We need to find people early that are failing because resistance may be happening more commonly than we think on DTG and we want to make sure that we find those people, and we get them on a regimen that's going to work for them,” he says.

Seidner says that as South Africa makes the transition of moving old HIV drugs to DTG, it is important that the health workers continue making sure that people remain in  a care framework and that their viral loads are monitored.

However, he says that the results do not mean that DTG is not going to work for the majority of people on treatment.

“We still think that DTG is a good regimen. And I think it's going to work for the majority of people. So I think our study should not be interpreted to say that is not the answer I think our study should be interpreted to say DTG is a good drug, it works well and in many people.

"But if you have drug resistance when you start it, there's a reasonable chance it's not going to work for you. And the only way to find that out is to make sure that just like before DTG was around, we continued to monitor people on treatment,” Seider says.

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