Tenofovir resistance and “super HIV”

Last week The Lancet Infectious Diseases journal published an article about the TenoRes study—a review of data from numerous countries about resistance to Tenofovir among people with HIV who had experienced treatment failure.

Tenofovir is one of the most widely prescribed drugs used to treat HIV around the world. It is available on its own and in various combination pills, including Truvada (and its generic equivalents). Developing resistance to Tenofovir reduces the available treatment options for a person with HIV, so understanding the circumstances of why this occurs and how to prevent it is very important.

Unfortunately, as is often the case, the headlines (and stories) in reports about this study were often alarmist and misleading.

A BBC article by Dominic Howell titled “HIV becoming resistant to key drug, study finds” was widely shared and appears to be the basis for many other articles. Though the BBC is often regarded as a reliable source, in its initial version the article failed entirely to mention that the study looked only at instances of people who’d experienced treatment failure. This gave the impression that 60% of all people with HIV in Sub-Saharan Africa showed resistance to Tenofovir. rather than the much smaller numbers actually reported in the study.

That article was eventually updated, though the updated version remains confusing and more alarming than it should.

Happily, Keith Alcorn at aidsmap.com has written an excellent summary explaining clearly what the LID study actually found and what it means. He is careful to address the confusion that has plagued most other reports on this study:

This study does not reflect the prevalence of HIV drug resistance in all people on treatment, nor the prevalence of drug resistance in people who have not yet started treatment, but only the prevalence of drug resistance in people who started specific drug regimens and subsequently experienced virological failure of that treatment regimen.

The whole article is well worth reading.

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