The fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, conducted in 2017 by the Human Sciences Research Council (HSRC) and its partners found resistance to anti-retroviral drugs (ARVs) in more than a quarter of virally unsuppressed people living with HIV. These findings were presented at a joint HSRC and United Nations Programme of HIV/AIDS (UNAIDS) World AIDS Day Seminar.

Resistance to any of the ARVs was identified in 27.4% of survey respondents who were virally unsuppressed. Resistance to one drug class was found among 18.9% of the respondents and 7.8% had resistance to two drug classes that constitute first-line therapy used in South Africa, while a smaller proportion (0.5%) had resistance to second-line regimens. 

Drug resistance was found in 55% of respondents who were on treatment and not virally suppressed, as well as in 75% of those who had stopped taking treatment. Furthermore, resistance was found in 15% of respondents who reported no previous exposure to ARVs. The levels of drug resistance were the same among males and females, and among children aged 0-14 years, the youth aged 15-24 years and adults.

According to Dr Sizulu Moyo, who is one of the co-principal investigators in the study, this is the first South African HIV household survey to include HIV drug resistance testing. As a household survey, it includes people who might have disengaged from care and those accessing care through the private sector. Therefore, it provides information that would not be provided by regular HIV drug resistance surveys that use data from public sector clinics.

“The results from this study are consistent with those reported in the 2017 World Health Organization HIV Drug Resistance report, where levels of resistance in persons failing first-line treatment are between 50 – 90%, and more than 10% in persons starting first-line treatment in Southern African countries. In addition, this research has shown that high proportions of patients that are no longer in care have resistance. The data supports efforts to keep patients in care, to switch failing patients to alternative regimens more quickly, and to introduce dolutegravir-based regimens in to the national treatment program”, said Dr Gillian Hunt an expert on HIV drug resistance from National Institute of communicable Diseases, who is a co-investigator in the study.

“The results are an important piece of evidence in that they provide a baseline to measure future success and they can also be used by the country to explore practical ways to improve HIV management,” said Prof Khangelani Zuma, one of principal investigators in the Study,.
“Understanding the current levels of HIV drug resistance and its potential impact on the HIV epidemic is especially crucial for South Africa which has the largest number of HIV-infected individuals on ARVs”, underscored Prof Thomas Rehle from the University of Cape Town, who was involved in the design of the study.

“There are clear policy and programmatic implications from these findings. Ensuring access to viral load testing and, if necessary, drug resistance testing, is a key component of global endeavours to reach to the 90-90-90 targets