Zimbabwe's remarkable progress in HIV treatment faces a new hurdle as cases of resistance to the life-saving drug, Dolutegravir (DTG), emerge. With over 1.2 million people currently on Antiretroviral Therapy (ART), accounting for approximately 90% of those living with HIV, the country's achievements in combating the disease are significant. However, the increasing instances of DTG resistance pose a considerable threat to the nation's hard-won gains.
In an interview with 263Chat, Dr. Cleophas Chimbetete, Director of Training and Research at Newlands Clinic highlighted that there is an urgent need to start having the conversation about what's next after third line.
Chimbetete explained that Zimbabwe's HIV treatment guidelines are informed by the World Health Organization (WHO).
"These guidelines recommend that individuals testing HIV-positive start a combination of three medicines, known as first-line ART. If the virus becomes resistant to these medicines, patients are switched to second-line ART, and subsequently to third-line ART if necessary," he said.
Dr. Chimbetete revealed that while DTG remains effective, instances of resistance are increasing. "We're beginning to see resistance to Dolutegravir... previously, the need for guidance on what to do after third-line treatment failure wasn't there, but now we need to start having that conversation," he cautioned. This development highlights the need for continuous monitoring and adaptation of treatment protocols.
Zimbabwe's HIV treatment landscape has evolved significantly since 2015, when the Ministry of Health introduced third-line ART. Today, various centers across the country provide third-line treatment to patients who have failed first and second-line ART. However, the emergence of DTG resistance necessitates a reevaluation of the nation's treatment strategy.
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The country's progress in HIV treatment is noteworthy, with 1.4 million people living with HIV, 1.2 million on ART, and over 95% viral suppression rate among those on treatment. Nevertheless, the rising cases of DTG resistance serve as a reminder that complacency is not an option.
Dr. Chimbetete emphasized the importance of research on DTG resistance, updated national guidelines for post-third-line treatment failure, continued training for healthcare workers, and strengthened patient adherence to treatment regimens. As a member of the Zimbabwe HIV Clinicians Society, he is actively engaged in addressing these concerns.
The Society, along with healthcare professionals and stakeholders, recognizes the urgent need for action. Zimbabwe remains committed to achieving the UNAIDS 95-95-95 targets: 95% of HIV-positive individuals knowing their status, 95% of diagnosed individuals on treatment, and 95% of those on treatment achieving viral suppression.
