With antiretroviral therapy, people with HIV can live long and healthy lives, but new research from the BC Centre for Excellence in HIV/AIDS (BC-CfE) and Simon Fraser University (SFU) shows that HIV strains circulating in Saskatchewan have adapted to evade the immune system and are causing illness more quickly.
These mutated strains are being transmitted more widely and more frequently, and if left untreated, can accelerate progression to AIDS, taking an individual from being relatively healthy, to having an extremely compromised immune system in a short period of time.
“Instead of it taking years, sometimes it just takes a month or a year and it’s much more aggressive than we would otherwise see,” Dr. Alex Wong, an infectious disease physician with the Saskatchewan Health Authority, told The Globe and Mail.
Since 2003, an HIV epidemic has been expanding in Saskatchewan, with incidence rates in some regions now more than 10 times the Canadian national average. Faced with this growing crisis, researchers compared more than 2,300 anonymized HIV genetic sequences collected from the Saskatchewan between 2000 and 2016 against data sets from sites across Canada and the United States. Worryingly, the results show not only a higher prevalence of immune-resistant mutations in Saskatchewan, but that their prevalence is increasing.
One key mutation was found in more than 80% of Saskatchewan HIV strains, compared with only 25% of HIV strains found elsewhere in North America. And in samples collected between 2015 and 2016, more than 98% harboured at least one major immune-resistant mutation.
In Saskatchewan, 80% of those with HIV self-identify as having Indigenous ancestry, and the researchers believe the resistant strains have adapted to the specific immune profile of the Indigenous population.
According to the study’s lead author Zabrina Brumme, Research Scientist with the BC-CfE and Associate Professor in SFU’s Faculty of Health Sciences, there is some good news—antiretroviral treatment works equally effectively against immune-resistant HIV strains.
Although antiretroviral treatment is effective, the challenge is ensuring everyone, including the most marginalized, has access to testing, treatment, and the support they need to take that treatment correctly. This will not only control a person’s symptoms, but also stop the mutated strains spreading.
Armed with this new understanding, and additional government funding for HIV medications and preventative treatment in the province, the researchers can work to improve targeting and evaluation of strategies to stop the virus spreading. In the meantime, the authors highlight the importance of individuals taking action to protect their health, getting tested and accessing treatment immediately following a diagnosis.
Study author Jeffrey Joy, Research Scientist with the BC-CfE, explains, “We know that HIV does not stay confined to geographical clusters—it spreads. We need to work together to make HIV testing routine and stigma-free.”