HIV1-Infection Drug Resistance - Essay Example

HIV1-Infection Drug Resistance HIV1-Infection Drug Resistance Problem and Investigation The resistance to antiretroviral therapy (ART) cases is increasing. The resistance limits the application of antiretroviral therapy methods to the infected individuals. There is the need to understand the trends of this resistance in the various environments so to develop measures to restore the strength of the drug. This problem is common in low and middle-income countries. However, there is increased advocacy for the usage of antiretroviral therapy; the resistance observed, as the disease spread to new people, is becoming a menace in these societies. The resistant version of the virus is predominant in people who acquire the virus in recent years (World Health Organization Report, 2012). The growing numbers of infected individuals who exhibit the resistant form of the HIV need to focus on second line regimens treatment. These treatments restore a genetic power in the bodies to fight the resistance to the antiretroviral therapy (World Health Organization, 2012). Problem Statement The purpose of this paper is to look at the resistance to the antiretroviral therapy, in middle-income countries like Brazil and Austria and introduce possible responses to this scenario. Middle-income countries face the worst conditions in combating the mutation of the HIV-1 virus that causes AIDS. The reason is that these third-world countries lack necessary research centers, financial logistics to sponsor researchers on the trends the disease is taking, and poverty index is high. Rational Antiretroviral therapy is the only existing response to the HIV/AIDS pandemic. The disease has already and continues to kill so many people in the world. The virus mutates to thrive in antiretroviral conquered environments. This is an obstacle as it will make scientists stop focusing on coming up with a cure and start thinking of fighting this resistance. There is the need, therefore, to understand why the virus mutates and consider the strength of second line regimens treatments as an alternative (World health Organization Report, 2011). The middle-income countries face the most challenges in trying to solve the virus’ resistance to ART. There is need for independent organizations from developed countries to carry out researches to explain these Assumptions The paper makes the general assumption that, in all low and middle-income countries, the resistance and rate of spread are the same. The opportunistic infections are the same in the people living with the disease in the low and middle-income countries. In addition to that, the assumption in this paper is that the resistance to antiretroviral therapy is due to mutation of the virus, and no other factors result in the case. Limitations The paper is limited in explaining the factors that contribute to the resistance observed in emerging cases. The reason or reasons as to why the virus mutates once it gets in new environments are not explained. Preview and Methodology The literature review in this paper looks at three different reports analyzing the emergence of the virus and its resistance nature. The case examples and general reports indicate a good analysis of the experience in low and middle-income countries. The literature analysis would include the main points that refer to the problem in question. Literature Analysis The resistance patterns of HIV-1 infection to ART, particularly in Nigeria, are devastating. It is prevalent on people who already are undergoing antiretroviral therapy. The development of resistance to antiretroviral drugs limits the use of antiretroviral therapy. For that reason, it is necessary to study and understand the patterns on display. Nigeria recorded its first HIV-AIDS case in the country, in 1986. The disease is prevalent among the people as the rate of spread and deaths are steadily increasing over the years. The surveys in the country, which reflect the trends in most West African countries, indicate that in 2003, the HIV infections rose to about 5.8% (Odaibo, Okwonko & Olaleye, 2013). Reports from international disease control bodies indicate that, in 2011, the overall infection in the world had reduction tendencies, and the prevalence was at 7.5% (Odaibo, Okwonko & Olaleye, 2013). These reductions are an attribute to the use of antiretroviral therapy (ART). The results are that there are minimal deaths due to HIV infections. These trends have made North American, European and South American state especially Brazil to advocate for the usage of antiretroviral drugs. The African countries adopted the method of using antiretroviral therapy (ART) after successful research in developed countries. In Nigeria, the use of antiretroviral therapy has roots on 2002 when the government with the help of international agencies came up with the pilot HIV treatment program. The program got funds from the US president’s Emergency Plan for Aids Relief to boost its operations (Odaibo, Okwonko & Olaleye, 2013). The drug and procedure have made people living with the virus live healthy. The virus mutates in various regions of the world and different people. For that reason, the usage of antiretroviral drugs (ARV) and therapy (ART) is facing challenges. The prevalence of the resistance to ART procedures indicates that the disease achieves new strides and manifests itself in new versions. The increase in cases of resistance to ART in people living with the HIV-1 infection, in low and middle-income countries, is alarming. The existing data detailing the level of resistance in these countries are to an extent mean the disease has overwhelmed the counter methods in place. These countries are poor, low growth in technology and lack trend indicators in research centers. They cannot consistently survey resistance and come up with possible solutions to combat the disease. The surveillance on this resistance provides quality information on the effectiveness of the antiretroviral therapy (ART) procedures. In the year 2011, about eight million people were under antiretroviral drugs, up from the number seen in 2003. The administering of antiretroviral drugs works miracles in controlling the extent of damage the disease can inflict on an individual (World Health Organization Report, 2012). Contrary to that, the world is experiencing mutating versions of the virus from its earlier nature. The advocacy by middle- income countries, like Nigeria, Portugal, and Brazil, to use antiretroviral drugs makes monitoring on the progress of the resistance to the usage of these drugs mandatory. The improvement of treatment in the last eight years has led to some levels of resistance, as the virus mutates to prevail in the changing environment. These resistant species are spreading quickly to areas where there were not. The resistance is common in non-nucleoside reverse transcriptase inhibitors (NNRTI). This is prevalent in new victims, but those who had the virus from previous infections did not exhibit any substantial resistance to the drug (World Health Organization Report, 2012). Secondly, the people who acquire resistant versions of the virus can receive second-line regimens could do well. This is because the second line treatment combinations are likely to be successful for most of these patients (World Health Organization Report, 2012). Second-line regimens therapy is a subsequent treatment administered when the initial therapies fail to respond to the infection. The therapy involves an adoption of a new regimens signal. This could be because of a failure of the initial therapy or the initial therapy led to some unexpected side effects. The first-line nonnucleoside reverse-transcriptase inhibitor (NNRTI) is predictable within the first twelve months. The patients achieve HIV RNA suppression within twelve months after the ART initiation. For that reason, patients who receive second-line therapy do not achieve HIV RNA suppression within six months of ART initiation. In addition to that, the surveillance and monitoring of the indicators of resistance gives appropriate information on the effectiveness of the antiretroviral therapy (ART) procedures in place. There is the need to avail information on these indicators of resistance to tracking the levels of mutation of the virus. This would help in improving the standards of healthcare for people living with the new version of the resistant virus (World Health Organization Report, 2012). The prevalence of the resistance to ART observed in people who acquire the HIV-1 infection is another angle n focus. The observation is attributed to a specific number of HIV-1virus mutations. For that reason, it is useful to understand and apply genotypic resistance testing procedures. The factors that lead to virological failure in patients who receive treatments should be explained to control their strength. In addition to that, antiretroviral treatment relies on the antiretroviral regimen and the individual’s number of HIV-1 mutations that can cause resistance. Antiretroviral resistance hinders the extent of application of antiretroviral therapy in people who acquire the mutant version of the HIV. Scientists use genotypic resistance to evaluate the resistance that exists in patients who acquire that type of virus. This testing also provides insights into the reasons behind the virological failure in patients who undergo treatment. This helps in achieving subsequent and second-line or second option salvage therapies (Tang & Shaffer, 2012). In patients who acquire the resistant virus, the response of the virological procedure to a regimen is similar to that of patients with mild types of the resistant virus. These types of patients have highest possibilities of containing a mild form of the resistant virus. The introduction of antiretroviral therapy boosts the existence of the protease inhibitor (PI). This drug has a high genetic barrier to resistance. HIV-2 results to about a third to the existence of HIV in West Africa and other low and middle-income regions. It presumably has its roots in Portugal. The HIV-2 makes it hard to identify and treat HIV, without introducing advanced technologies. The natural existing polymorphisms and the resistance patterns to ART are major problems in combating the HIV -1 infection. The Non-nucleoside reverse transcriptase inhibitors, which are important in inducing the first-line regimens for HIV-1 infections in most of the low-income regions, have no significant result on HIV-2 infection (Kevin, P. et al. 2011). The HIV-2 infection is the resistant version of the disease in this case. The initial application of the first types of the nucleoside is not enough to induce a permanent virologic control mechanism. The previous usage of protease, which did not include ritonavir boosting, has no effective results in HIV-2 infection (Kevin, P. et al. 2011). The use of Highly Active Antiretroviral Therapy (HAART) has brought considerable reductions in the mortality and morbidity concerned with the HIV infection. It is evident that factors that include interruptions in the application and usage of ART, missing doses of medical strength against HIV-2, and the use of monotherapy in the initial stages of applying HAART lead unforeseen clinical drug resistance and failure of the virologic methods. The numbers of virological factors that result in antiretroviral drug resistance are many. These factors include the mutation of the virus associated with HIV infection, heterogeneity of the circulating viral quasispecies in the system, and the failure of proofreading and the infidel reverse transcriptase results to some quasispecies of the virus circulating in the system (Payday et al. 2013). The levels of resistance to ART are observed majorly in low and middle-income countries. A recent study shows that in Guinea-Bissau, the people living with HIV-1 and HIV-2 use and depend on antiretroviral treatments. The widespread use of the antiretroviral therapy has seen significant obstacles in combating the strength of both HIV-1 and HIV-2 infections. The last ten years has seen an increase in the use of antiretroviral therapy in the fight against HIV-1 infections in most parts of Sub-Saharan Africa. The application saved many lives from early deaths due to opportunistic infections like malaria and typhoid. However, reports have emerged highlighting the resistance to antiretroviral therapy hence it has become an obstacle to fight the disease (Hamers, 2013). These reports are mainly associated with the resource-poor countries like the Sub-Saharan Africa, Nigeria, Cameroon, Uganda and Congo. These countries merged to establish the PharmAccess African Studies to Evaluate Resistance (PASER). The PASER networks network was established in South Africa, Nigeria, Kenya, Uganda, Zimbabwe, and Zambia in 2006 to evaluate the trends of resistance and recommend on the best approaches against that. The researches in these networks are independent but rely on the findings of each center for better understanding. The main points This paper presents the following points about the resistance patterns of HIV-1 infection to antiretroviral therapy. (1) The paper highlights the prevalence of the resistance to ART in low and middle-income countries, like Kenya, Nigeria, Brazil, and Portugal. (2) The various methods put in place to monitor the resistance patterns of the HIV-1 infection to ART. (3) The measures these countries are employing to combat the resistance to ART in people living with HIV. (4) In addition to that, the paper recommends possible measures like administering a second regimens treatment to induce a genotypic virological resistance, to fight the resistance to ART. This research gives credit to the reports of the World Health Organization on disease control, the literal works of Tang & Shaffer, and the other works as listed in the reference list. . References Hamers, R.H. (2013). Drug-resistant HIV-1 in sub-Saharan Africa. Clinical and public health studies. Vol. 2013; 82:e11-e14. Maastricht. Kevin, P. et al. (2011). Antiretroviral Therapy for HIV-2 Infection. Recommendations for Management in Low-Resource Settings. Volume 2011 (2011), Article ID 463704, 11 pages. Odaibo, G.N. Okwonko, P., & Olaleye, D.O. (2013). Pattern of HIV1 Drug Resistance Among Adults on ART in Nigeria: World Journal of Aids, (2013, 3, 327-334). Ibadan. Payday et al. (2013). Emerging HIV Drug Resistance in the Resource Poor-World: Challenges And Strategies. Aids & Clinical Research. S5-006. Tehran. Tang, M. W., & Shaffer, R.W. (2012). HIV-1 Antiretroviral Resistance: Scientific Principles and Clinical Applications, (2012, 23, 5-8). Stanford. World health Organization. (2012). World Health Organization (WHO) HIV Drug Resistance Report 2012: HIV/AID Programme. Geneva. Read More