Report By: Bunmi Yekini
Around 2.6 million children and adolescents worldwide are living with HIV, with the majority in Africa. These young patients face a higher likelihood of treatment failure compared to adults. While experts have traditionally believed that testing for viral drug resistance could enhance treatment effectiveness, a new study from the University of Basel suggested that ensuring patients consistently take their medication is far more critical.
Antiretroviral drugs have been a game-changer in the fight against HIV, effectively keeping the virus in check and preventing its transmission. However, the emergence of drug-resistant variants poses a significant challenge. In high-income countries, doctors routinely test for resistance mutations when treatments fail, but in resource-limited regions, such tests are not readily available. As a result, healthcare providers often have to make educated guesses about alternative treatments, which may not always address the underlying issue if the problem is inconsistent medication adherence.
In light of ongoing discussions about improving HIV treatment success in African countries with limited funding, researchers led by Professor Niklaus Labhardt at the University of Basel embarked on a study to assess the effectiveness of resistance testing. Their research, published in The Lancet Global Health, involved 284 children and adolescents aged six months to 19 years from clinical centers in Lesotho and Tanzania. All participants were on antiretroviral therapy but still had high HIV viral loads.
The study divided the participants into two groups: one received resistance testing by specialists, while the other received standard care with repeated viral load testing and empirical treatment. The results were striking. Thirty-six weeks into the study, there were no significant differences in viral load between the two groups. This finding contradicts the long-held belief that resistance tests would substantially improve treatment outcomes.
Dr. Jennifer Brown, the study’s lead author, summarized the findings, stating, “This contradicts the assumption that treatment supported by resistance tests would meaningfully improve clinical and virological outcomes.” The study’s results suggest that the main reason for persistent high viral loads is not drug resistance but rather inconsistent medication adherence.
Study leader Niklaus Labhardt emphasized, “Improving adherence to therapy would be more effective than introducing resistance tests more broadly. This finding is crucial because it helps us prioritize where we want to allocate the limited funding for HIV programs.”
The researchers hope that these findings will lead to more resources being directed toward programs that address the specific needs of children and adolescents, ultimately improving their adherence to treatment. At the same time, it’s important to better identify individuals at the highest risk for viral resistance to ensure targeted and cost-effective resistance testing.
The study was a collaborative effort involving experts from the Swiss Tropical and Public Health Institute, the non-profit organization SolidarMed, the Baylor College of Medicine Children’s Foundation, and health institutions in Lesotho and Tanzania. It was financed by the Fondation Botnar, the Swiss National Science Foundation, and the Gottfried und Julia Bangerter-Rhyner-Stiftung.