Pediatric HIV Drug Resistance Testing, Zim’s Health Time-bomb

APPROXIMATELY 1.8 million children under the age of 15 have HIV globally, and almost 90% are living in Sub Saharan Africa (SSA) with 77,000 of those in Zimbabwe.

By Michael Gwarisa

Efforts are underway in Zimbabwe to initiate as many children as possible  who are born HIV positive on Antiretroviral Therapy (ART), and Zimbabwe seem to be winning on that front. However, even with access to ART, rates of treatment success for children and adolescents are lower than adults across Africa.

According to Johnson and Johnson, Children are more prone to developing drug resistance to first line therapies with studies showing that most children failing ART have evidence of drug resistance, highlighting the urgent need for follow-on treatment regimens to which resistance has not developed.

The remaining options after children would developed resistance to first-line therapy is the second or third line regimens whose cost is beyond reach of many struggling governments hence the need to manage HIV in patients to ensure demand for such treatment options does not balloon beyond comprehension.

Dr Angela Mushavi, paediatric HIV Care and treatment coordinator MoHCC

National Prevention of Mother to Child transmission (PMTCT) and pediatric HIV Care and treatment coordinator in the ministry of health, Dr Angela Mushavi said drug resistance in children was difficult to manage and the country needed to scale up HIV drug resistance testing services.

The issue of access to HIV drug resistance testing is something that we are really ceased with as a country because HIV drug resistance testing is expensive. Our own laboratory, the National Microbiology Reference Laboratory (NMRL) has been trying to build full capacity to do HIV drug resistance.

“So far they can only do part of the process on samples that are submitted or sampled with NMRL, but for the actual Genotype resistance testing, interpreting and so on, they have to ship specimens out of the country and get other laboratories that are out of the country to support with the resistance testing,” said Dr Mushavi.

She added that Zimbabwe needed to build its local capacity to be able to do resistance testing locally since shipping outside is costly. At the moment Newlands Clinic offers HIV drug resistance in the country but at a very high cost.

“Newlands clinic has a service and they can do HIV drugs resistance testing but they are almost like a private facility, a not for profit private facility. If we were to send a sample for testing at Newlands clinic, then we would have to pay US$200 000 for that sample to be processed.

“So can our clients afford it and can our government afford it. It’s a big question and we all can figure out what that means in terms of access. It is a bottleneck and we need to strengthen that.”

Dr Mushavi added that HIV drug resistance is very high in children and majority of the infections are contracted either during the pregnancy period or at breastfeeding level.

“For children that are HIV positive, the majority of them is through mother to child transmission of HIV and that being the case, women that are HIV positive are put on ART treatment and some of that treatment includes Efavirenz which is a non-nucleoside reverse transcriptase inhibitors (NNRTIs).

“Previously, before we were using Efavirenz, we were also using Nevirapine  in pregnant women and we still to this day use Nevaripen in children that are HIV exposed and uniquely it’s very easy to develop resistance to those two medications. So children then through exposure of the mother, develop resistance and that why we have high HIV drug resistance in children,” said Dr Mushavi.

According to the World Health Organization (WHO) Drug Resistance Report for 2019, Zimbabwe is among one of the 18 countries that recorded HIV drug resistance above 10% percent amidst indications that more women showed resistance to first line regimens efavirenz/nevirapine.

In the SADC region, South Africa tops the list with a 23.6% Pretreatment Drug Resistance (PDR) to efavirenz/nevirapine followed by Namibia which has  a 13.8% PDR to EFV/NVP while Zimbabwe has 10.9% PDR to EDF/NVP. However, national guidelines in all these countries have been revised to include the use of DTG as preferred first-line ART for adults and adolescents (in women and girls of childbearing potential through informed choice).

Meanwhile, Janssen Pharmaceutical Companies a subsidiary of Johnson & Johnson recently donated a sizable quantity of Third-line Antiretroviral (ARV) drugs to Zimbabwe as part of its efforts to address the huge ARV drug resistance burden prevalent in children and young people.

Through a program dubbed the New Horizons Collaborative, an integrated approach to improving pediatric HIV care, a total of 5000 children from the SADC region are set to benefit. Through the program, Janseen provides Darunavir and Etravirine, including child friendly formulations, free of charge to eligible countries with the clinical capacity and willingness to address second and third-line pediatric HIV treatment

Johnson & Johnson senior director, global public health, Usheema Maraj De Villiers said, “We have made tremendous progress in delivering HIV therapies to people in developing countries, overall, but we must do better for children. New Horizons is a collaborative initiative to build awareness, inspire action, and advance learning around the unmet needs of HIV treatment-experienced children and adolescents.”



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