HIV drug resistance in Southeast Asia: prevalence, determinants, and strategic management

Background: Human immunodeficiency virus (HIV) drug resistance is the ability of HIV to mutate such that it reduces the ability of antiretroviral drugs to block virus replication. This can lead to suboptimal treatment outcomes, treatment failure and continued community transmission of drug resistant HIV strains. The rapidly rising HIV drug resistance rates in low- and middle-income countries pose a critical challenge to ending the HIV epidemic. In Southeast Asia, where national surveillance of HIV drug resistance is lacking, there is an urgent need to understand this public health issue to effectively curb HIV. Methods: Literature review and interviews with key informants across Southeast Asia were conducted to understand the trends of HIV drug resistance in Southeast Asia, including prevalence rates, factors causing drug resistance, and policy strategies for combating HIV drug resistance. Results: HIV drug resistance prevalence rates in Southeast Asia were generally low to moderate. The key determinants of HIV drug resistance identified relate to barriers undermining treatment adherence and retention, particularly geographical access and the cost of travelling for treatment, stigma and discrimination, and the lack of patient confidentiality at health facilities. Most Southeast Asian countries have adapted WHO treatment guidelines and were in the process of transiting to using antiretroviral drugs with higher genetic barriers to resistance. However, resource constraints and limited laboratory capacity have hindered their ability to conduct routine viral load monitoring for all patients and testing of HIV drug resistance. Conclusions: Most Southeast Asian countries are making progress in managing HIV drug resistance. However, to achieve the UNAIDS global target of maximal viral load suppression in 90% of all people receiving antiretroviral therapy, Southeast Asian countries need to address barriers to treatment adherence and retention, expand viral load testing coverage and drug resistance testing availability, and make dolutegravir available as a treatment option.