by Mike Andrew - SGN Staff Writer

Drug-resistant HIV strains have been increasing over the last decade in sub-Saharan Africa, according to a new study published in The Lancet medical journal.

Researchers from the World Health Organization (WHO) and University College London (UCL) found the most rapid increase in drug resistance occurred in east Africa, at 29% per year. In southern Africa, it was 14% per year.

There was no change in resistance over time in West and Central Africa or in Latin America, the study found.

'Without continued and increased national and international efforts, rising HIV drug resistance could jeopardize a decade-long trend of decreasing HIV/AIDS-related illness and death in low- and middle-income countries,' Dr. Silvia Bertagnolio of WHO and Dr. Ravindra Gupta of UCL wrote in The Lancet.

Drug resistance is often a consequence of failure to adhere to a regular regime of medication. Viruses vary in their vulnerability to antiviral drugs, and the merely episodic use of them will kill off the weakest viruses while leaving the most resistant ones to reproduce. Over multiple generations of viruses, a new, drug-resistant strain may emerge.

Gupta told BBC reporters that the study revealed that patients in the affected areas were not receiving effective treatment that supported adherence to their med schedules.

'Drug resistance is a consequence of people not taking their medication properly,' he said.

'We do expect to see drug resistance, and it's at around 10% in the U.K. and the U.S. But here, we monitor people regularly and switch people to different drugs if they develop resistance.'

Gupta added that very basic measures could help people to adhere to drug regimes in developing countries, such as access to food and clean water, and closer monitoring of patients.

No changes were needed to the drug regimes themselves, the researchers said, but Gupta added, 'This work gives us an early warning that things could get worse.'

Deborah Jack, chief executive of the British National AIDS Trust, called for more treatment options for patients in sub-Saharan Africa.

'In the U.K., we are fortunate that drug resistance is not a serious problem, and if a person has drug resistance there are other combinations of anti-retroviral therapy that we can use to address this,' she told the BBC.

'Sadly, in sub-Saharan Africa fewer treatment options are available. If drug resistance occurs, there doesn't tend to be an alternative therapy.

'We need further research into the causes of this drug resistance in Africa, and urgent action to support people's daily access to their medication.'

Sub-Saharan Africa has been particularly hard-hit by the HIV/AIDS epidemic, with some 22.5 million of the world's 33.3 million HIV cases.

Perhaps 5% of the total population of sub-Saharan Africa between the ages of 15 and 49 are now living with HIV, and in southern Africa the percentage may be as high as 15%. In east Africa, where the greatest increases in drug-resistant HIV strains were discovered, the HIV infection rate is between 5% and 15%.

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