Research Impact


Understanding HIV drug resistance informs national and international strategy on HIV treatment

Spilled pills

14 December 2014


UCL investigators have been at the forefront of characterising and assessing HIV drug resistance since 1990, soon after the very first HIV drug was licensed. This work has directly influenced the rollout of anti-retroviral therapies in the UK and around the world.

An estimated 35 million people are infected with HIV worldwide, with the vast majority living in resource-poor settings. HIV therapy is now provided as a combination of three drugs, in order to prevent drug resistance developing. UCL research has been at the forefront of understanding the nature and impact of drug resistance and has therefore shaped all national and international treatment guidelines since the early 1990s.

The first trials of anti-retroviral therapies began in Europe in the early 1990s, but apparently showed a lack of treatment effect. UCL researchers developed novel gene sequencing methods to show that this was due to drug resistance. As a result, the UK HIV Drug Resistance Database was established at UCL in 1999 by Professor Deenan Pillay (UCL Infection & Immunity). Its purpose was to map the spread of drug resistance by HIV in the UK, including the transmission of resistance. This information then guides the choice of therapy according to individual resistance patterns, and has led to a fall in the spread of drug-resistant forms of the disease in the UK over the last 10 years.

This national-level collaboration was then extended, firstly into a Europe-wide database, then looking at transmission of drug resistance on a global scale. By examining resistance emerging in trials across sub-Saharan Africa, the researchers highlighted the risk of a large-scale transmission of resistance across the resource-poor world. Recently, they have indeed demonstrated that such transmission is now a reality.

In response to this, UCL led a major seminar on the 'Impact of HIV drug resistance in the resource poor world' in conjunction with the World Health Organization (WHO) in Geneva in 2012. This was the first such meeting to include both generic and proprietary drug producers, to establish the future of rational drug treatment for the developing world. As a consequence, in 2013, the WHO changed its surveillance strategy to better guide appropriate interventions in the developing world. Based on UCL findings from the UK population, WHO established a monitoring function, in parallel with the rollout of antiretroviral therapy.

Professor Deenan Pillay has now been seconded to become Director of the Wellcome Trust Africa Centre for Health and Population Sciences, in South Africa, thus enabling the application of this research to one of the areas with the highest HIV prevalence in the world.