Expert warns vs emergence of drug-resistant HIV

MANILA, Philippines - With 26 Filipinos diagnosed with the Acquired Immunodeficiency Deficiency Syndrome (AIDS) every day, an infectious disease expert from the University of the Philippines (UP)-Manila has cautioned against the emergence of drug-resistant human immunodeficiency virus (HIV) in the country.

According to Edsel Salvana, director of the Institute of Molecular Biology and Biotechnology at the UP-Manila’s National Institute of Health (NIH), the country is now starting to see HIV cases that no longer respond to the antiretroviral treatment (ART).

Citing the October 2016 partial results of a study being done by NIH and the Department of Health (DOH), he said some cases have developed resistance to ART after a year. 

Salvana noted in a forum that of the 458 HIV patients at the Philippine General Hospital that they observed, 45 or 9.8 percent “were not virally suppressed.”  The study intends to recruit at least 600 patients. 

“This means the level of the virus in their blood is not detectable and that the virus is not reproducing but remains inside the cells it infected.  If the medication is stopped, the virus starts replicating again,” he said.

The expert said the development of resistance is correlated to “whether you are taking your medication or not.”

“But what is interesting is that we found – assuming they were telling the truth – that only 14 of the 45 who were not virally suppressed admitted missing a pill (in the past year).  That is scary,” he pointed out.

This means that there is now a transmission of drug-resistant virus in the country, he concluded.  

“We are doing 200 patients, but so far we have (finished) only 80 and yet there are already three patients with transmitted drug resistance,” Salvana said. “And this is using the conventional means. We are also using a new technique that is more sensitive to sequencing.  It will help us figure out how much transmitted drug resistance is in the Philippines.”

Alarming

Salvana said having transmitted drug resistance in HIV cases is “concerning” because unlike in the United States which has 30 to 40 HIV drugs, the Philippines only has seven drugs for ART.

The ART drugs are tenofovir, lamivudine, zidovudine, efavirenz, nevirapine and ritonavir/lopinavir. The last one is a combo that is considered just one drug.

In the Philippines, the first line of medication is a combination of tenofovir + lamivudine + efavirenz or a 3-in-1 pill that is taken once a day for life by a patient.

The study also showed that of the 45 patients who were virally suppressed, 39 had shown “clinically significant resistance mutation.”

“This is the worst part.  Fifty-eight percent (26/45) or those who failed treatment did not have an appropriate local second-line regiment of three active drugs,” he cautioned.

Salvana added that because of these findings, the DOH is now planning to acquire more HIV drugs. 

Free drugs

The expert called on the public to get tested for HIV, saying that Filipinos are fortunate because the government is providing ART for free.  In the US, the simplest ART costs around $700 to $800 a month.  

“ART is life-sustaining; it is not a cure. It is important to start on ART early. If you start at ART with CD4 count of above 500, you will restore life expectancy. You will die with HIV, not of HIV,” he said.

CD4 pertains to the cells in the body that is attacked by the AIDS virus. The normal CD4 count is 500 and above. 

Aside from restoring life expectancy, ART also decreases the risk of transmission by 96 percent, much higher than condom, which is only 85 percent effective.

Salvana added it takes eight to 10 years to develop full-blown HIV and if a person already had AIDS, he is likely to live for six months to one year only if he does not start on ART soon enough.

DOH data show that from January to October 2016, there are 7,756 documented HIV/AIDS in the Philippines. Counting from 1984, there are 38,114.

In 2008, one case was being recorded daily. But in 2010, cases rose to four cases daily, nine cases in 2012, 17 in 2014 and 26 cases this year.  

Sexuality education

Meanwhile, the DOH said yesterday the government’s planned condom distribution in public schools would not come soon, but sexuality education must first be included in the curriculum.

In an interview, DOH spokesman Eric Tayag said only students who have completed their sexuality education would be given condoms if the Department of Education (DepEd) approves the program.

“It’s not as if we’ll be going around schools to give out condoms to students. This is in line with the provision in the RH (Reproductive Health) Law that DepEd must roll out sexuality education,” he said.

Tayag said the DOH had considered such requirement when it thought of the condoms project.

The DOH also considered the results of its surveillance that the 15-24 age group accounts for the second age group with the highest cases of HIV/AIDS.

Tayag added the DOH had also noted previous studies showing that low condom usage in the country was due to non-availability of condoms.

“All these three were taken into consideration,” the health department spokesman said. “We have to remember that the most vulnerable are those 15 years old and above. They are the senior high school.”

Earlier, Health Secretary Paulyn Ubial announced that the DOH plans to give out condoms in schools as part of efforts to combat the spread of HIV/AIDS.

The Catholic Bishops’ Conference of the Philippines opposed the plan, saying the government should focus instead on educating the students against engaging in casual sex.

According to Tayag, the condoms will not be given directly to the students, but to the school clinics.

He said the school would have to explain the program to the parents so they would understand the problem and also help educate the students.