I recently published a review paper on HIV drug resistance. It was the first time I wrote a review paper and I enjoyed it thoroughly! It is also my first paper with Stanford as my affiliation: I walked the beautiful Stanford campus and enjoyed the sun in the breaks from writing.
Many of you probably know that the majority of the world’s HIV patients live in poor countries, especially in southern Africa. You may not know that many of these people are now receiving very good treatment. I had the unique opportunity to see the effects of improved access to treatment “on the ground” in Africa.
Last summer I was in Ethiopia for a few weeks and stayed in the Medhen social center in one of the slums in Addis Ababa. I knew that, for many years, much of the efforts of the Medhen center had focused on HIV/AIDS, and I was expecting to see the devastating effects of HIV/AIDS during my visit. However, the situation had changed a lot. The Ethiopian government now provides HIV drugs free of cost and most HIV infected people in the slum were doing well. In fact, there was no way for us to know who was infected, unless one of the nurses told us. The social center still supports some HIV patients, such as infected orphans who need financial and social support, but most of the center now focuses on “normal” poverty relief: housing, education, employment etc.
The World Health Organization also reports that access to treatment has improved dramatically in low- and middle income countries: from 300 000 people in 2002 to 9.7 million in 2012 (see here).
HIV treatment almost always consists of a combination of three drugs, often in a single pill. However, treatment only works well as long as the virus is not resistant against the drugs used. Fortunately, there is good news about drug resistance too: HIV treatments have become better and better at slowing down the evolution of drug resistance. Thanks to powerful drugs and close monitoring, many patients are now treated for many years without having any resistance problems.
In my review paper I describe that drug resistance is virtually solved in rich countries, but still a problem in poor countries. One reason for this is that poor countries often lack the possibilities to monitor the viral load of patients and to sequence the patient’s virus.
The paper also describes what is know about the relevance of pre-existing mutations for the evolution of drug resistance in a patient (also known as standing genetic variation or minority variants, depending on which field you’re from). Finally, I write about pre-exposure prophylaxis (taking HIV drugs to prevent infection) and how this is related to drug resistance.
I hope you enjoy reading the review paper as much as I enjoyed writing it!
You can download the paper here: 2013PenningsHIVReviewIDR