Political strife undermines HIV treatment

Among other tragedies in countries with HIV epidemics, political violence can have the additional long-term consequence of an increase in viral resistance to treatment and HIV treatment failure, say the authors of a new paper in AIDS Reviews. The researchers, who have studied post-strife treatment failure and resistance in Kenya, argue that officials and health care providers need to study and prepare for how violence disrupts antiretroviral treatment and complicates the epidemic.

PROVIDENCE, R.I. [Brown University] - As Kenyan citizens negotiated the tensions following the March 4 nationwide elections, memories of the violence that followed the December 2007 vote weighed heavily for many reasons. Among those in any nation with an HIV epidemic, argue authors of a new paper in AIDS Reviews, should be the long-term damage that political conflict can do to public health by disrupting treatment and thereby promoting resistance to antiretroviral drugs and treatment failure.

“It’s the long-term consequences that make this a bigger issue,” said lead author Marita Mann, who began studying the rise of drug resistant HIV in the wake of Kenya’s 2007 strife when she was a Brown University Master of Public Health student. She is now a doctoral student at the University of Washington. “First there are the patients who are affected themselves during the conflict and may be resistant to treatment later on, but this also may lead to transmitted resistance that will be a bigger problem in the epidemic.”

This time around in advance of the elections, Mann said, some Kenya health workers gave their patients extra supplies of medicine and papers that would help them transfer to another clinic in case they were displaced by new violence. In 2007, more than 1,000 Kenyans died and about 300,000 were displaced.

But many policymakers and health officials in HIV- and strife-ridden nations have not recognized the link between disrupted treatment and the potential for increased treatment failure and viral resistance, said senior author Dr. Rami Kantor, associate professor of medicine at Brown University and an infectious diseases physician at The Miriam Hospital in Providence.

The paper seeks to make that link clear by explaining how an unplanned treatment interruption can lead to increased viral drug resistance and treatment failure and by describing the research needed to mitigate the effects of treatment interruption in future conflicts.

The paper provides an overview, but the underlying concern is neither prospective nor hypothetical. In data they have presented at an international HIV conference but not yet published, Mann, Kantor, and colleagues from the AMPATH academic medical collaboration in Kenya found that after the 2007 violence, treatment in subjects whose drug regimens were interrupted by the conflict failed significantly more often than treatment in subjects who did not suffer a conflict-related disruption.