With the world falling behind in its effort despite unprecedented progress to end the scourge of AIDS by 2030, this year's World AIDS Day underlines the urgency to step up the fight against the epidemic, which has taken the lives of at least 32 million people. Nearly 75 million have been infected since the scourge began
One of the major threats lurking to reverse the gains made in combating AIDS is antimicrobial resistance, which develops when microorganisms like bacteria, virus, fungi, and other parasites undergo genetic changes, making them resistant to the medicines that they responded to earlier. This is an evolutionary change, but the process can be accelerated due to overuse or misuse of drugs in humans, animals, and food production. It can also be exacerbated by lack of water and sanitation and simple prevention measures such as infection control and vaccination.
The 20th International Conference on AIDS and STIs in Africa taking place in Kigali, Rwanda, is yet another opportunity to focus on tackling antimicrobial resistance in the context of HIV, sexually transmitted infections (STIs), tuberculosis and other HIV-associated and non-associated conditions.
"Antimicrobial resistance and drug-resistant infections pose the greatest threat in achieving the Sustainable Development Goals including our efforts on universal health coverage and the elimination of AIDS as a public health threat by 2030," said Dr. Haileyesus Getahun, director of Global Coordination and Partnership on Antimicrobial Resistance at the World Health Organization.
There are a lot of untapped opportunities of synergy between disease-specific programs, like HIV and TB, “and the response against antimicrobial resistance for better outcomes to patients, their families, and communities, particularly in resource-limited settings," Getahun said.
Maximizing the application of the public health approach and infrastructure of TB and HIV programmes, particularly on laboratory strengthening, integrated and standardized surveillance, ensuring access to quality and affordable drugs and infection prevention and control measures will be critical to advance the response against antimicrobial resistance, and it will be mutually beneficial for both-the TB and HIV, and the is antimicrobial resistance communities, he said.
In India, almost 5 percent of new HIV-infected people are found to be already resistant, according to Ishwar Gilada, a governing council member of the International AIDS Society, who said that patients who stay on antiretroviral therapy (ART) for longer periods tend to develop resistance to the drugs.
“So, like in the United States, the ART centers in India and other HIV high-burden nations in Africa and other regions, should perform the drug-resistance tests," he said, appealing that Indian pharmaceutical generic companies should also focus on making genetic viral load and resistance test kits, which would lower costs substantially, as for ART medicines. Then India and African countries can do resistance testing either before starting the ART or at the first virological failure.
Despite being preventable and curable, TB remains the most common opportunistic infection, and the biggest cause of death among people living with HIV. Some 250,000 people with HIV died due to TB in 2018. Annual drug-resistant TB cases have hovered around half a million globally over the past several years. Anti-TB drug resistance is not only impacting the fight against TB but also undermining efforts to eliminate HIV by 2030.
"The emergence of resistance to antimicrobials and the transmission of drug-resistant infections and diseases are major concerns of global health which threaten animal and human health, food supply, and food safety worldwide", Getahun said, adding that drug-resistant pathogens can circulate between humans, animals and the environment. Misuse and overuse of antimicrobials in animals, humans or plants is a major factor driving the emergence and development of antimicrobial resistance.
Antimicrobial resistance is a complex problem that requires a comprehensive response by way of a 'One Health' approach, including human, animal, food safety and security as well as the environment. Efforts to combat antimicrobial resistance across the One Health spectrum should embrace public health at the center, Getahun added, saying there is no better opportunity than drawing lessons from HIV and TB program to enhance programmatic scale-up to tackle antimicrobial resistance including through universal health coverage.
The heads of 193 countries have committed to deliver on the promise of Universal Health Coverage (UHC) along with other SDGs. In the leadup to World UHC Day on December 12 combating is antimicrobial resistance is a critical cog-in-the-wheel for sustainable development, including eliminating HIV as a public health problem, where no one is left behind. While the call for accelerating research and development for new treatments is rightly getting more attention, we should make sure that we do not lose the efficacy of existing drugs to antimicrobial resistance.
Shobha Shukla is the Managing Editor of Citizen News Service and coordinator of the Asia Pacific Media Network to end TB & tobacco and prevent NCDs. See her tweets at @shobha1shukla or visit www.citizen-news.org.