Antimicrobial resistance refers to microorganisms, including bacteria and viruses, responding differently to antimicrobial drugs. Because of this changing response, the viral or bacterial infection cannot be treated anymore by our existing antimicrobial drugs. Changes are seen more and more in ‘simple’ treatable infections, including pneumonia and tuberculosis, and this trend is a serious threat to global health.
Microorganisms becoming resistant to antimicrobials is a natural process. The genetic structure of bacteria and viruses changes over time, and when they are exposed to a antimicrobial agent, those organisms less susceptible than the others survive, creating resistant forms.
However, humans speed up those natural processes and thereby worsen the problem. Human impact can be divided into three categories
- Misuse. Misuse refers to bioindustry providing their healthy animals with antibiotics as growth promoter and to prevent disease. Resistant microorganisms developing here can later on spread to humans.
- Overuse. Overuse refers to doctors prescribing antibiotics to patients when not necessary, for example for a cold or for a flu. This happens also in developing countries where no clear treatment guidelines exist. Overuse also refers to using antibiotics as a prevention method, for example after surgery.
- Underuse. This is the case when patients don’t finish the antibiotic course or take a lower dose than prescribed. This is also seen in developing countries, where patients stop taking the medicine as soon as they start to feel better.
Tuberculosis
Worldwide, tuberculosis is in the top 10 causes of death. In infectious diseases, TB is the leading cause of death. People infected with HIV have an increased risk of TB, since HIV affects the immune system. Without treatment, chance of dying is 45%, for HIV-positive patients this is almost 100%.
Drug resistant tuberculosis is forming a big problem in many parts of the world now. The WHO estimated that in 2014, 480,000 new cases of resistant TB occured. Because this form of TB is resistant to the two most powerful drugs, patients must be treated with longer, less effective and because of this much more expensive drugs. Multidrug resistant TB is an emerging problem in East-Africa.
HIV
Another relevant topic in East-Africa is drug resistant HIV. Not only bacterial, but also viral treatments are subject to resistance problems. When the antiretroviral therapy those with HIV undergo does not work anymore, this can lead to the individual getting sicker and eventually developing aids, and risk of this resistant HIV form spreading through the community as well.
HIV drug resistance is caused by a mutation in the genetic structure of HIV that affects the ability of a drugs to block the replication of the virus. The WHO states that all current ARV drugs, including newer classes, are at risk
of becoming partially or fully inactive due to the emergence of resistant virus. Since HIV treatment is successfully being scaled up and more individuals are taking ARV, it is likely that HIV drug resistance will increase.
Research has proven that also in East-Africa, prevalence of a resistant HIV form is increasing. Since the HIV epidemic is still causing many problems in countries in this area, resistance will cause many more. It is important to consider resistance in HIV.
Sources:
– https://www.sciencedirect.com/science/article/pii/S1473309917307028
– https://www.sciencedirect.com/science/article/pii/S1472979213001583
– https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance
– https://www.who.int/en/news-room/fact-sheets/detail/antimicrobial-resistance
– https://www.who.int/news-room/facts-in-pictures/detail/antimicrobial-resistance
– https://www.who.int/news-room/fact-sheets/detail/tuberculosis
– https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/21/56/drug-resistance
– https://apps.who.int/iris/bitstream/handle/10665/255883/9789241512848-eng.pdf?sequence=1
East Africa 
Dear Group,
I like how you explain that antimicrobial resistance can have an effect on HIV as well as tuberculosis. While antibiotic resistance is quite widely discussed, I wasn’t so much aware of antiviral resistance. The different mechanisms of overuse and misuse of antibiotics are certainly a really important emerging problem worldwide, and especially in countries that have no regulation on antibiotics. I do wonder however, what the (human) reasons for the increase in resistant HIV are? Since it is viral, it doesn’t respond to antibiotics anyways. Is there also a mis- and overuse of antiviral drugs leading to an accelerated gaining of resistance among HIV viral strains?
With kind regards,
Lydia
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Hi Lydia, thanks for your question. The problem in HIV is indeed similar to the problems related to antibiotics. WHO states: “HIVDR is caused by a change (mutation) in the genetic structure of HIV that affects the ability of a particular drug or combination of drugs to block the replication of the virus. As efforts to scale up treatment continue, and more individuals receive antiretroviral (ARV) drugs for the treatment or prevention of HIV, it is likely that a further increase in levels of HIVDR (Box 1) will compromise the substantial gains already achieved in the HIV response, and threaten efforts to expand treatment further and achieve even greater impact globally.”
We will edit the post a bit so this becomes more clear.
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Dear everyone,
What an interesting blog post, once again. Like Lydia has already mentioned, I found it quite interesting to learn about the effect of antimicrobial resistance on tuberculosis as well as HIV. Maybe you can use some pictures or graphs to make it even more appealing to you readers. Moreover, I was wondering on your thoughts on what would be the best intervention in order to tackle the problem. Especially looking at the human influence, this must me an important topic in order to make new policies for the future generation. I’m looking forward to your answer.
Kind regards,
Amber
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Dear Amber, thanks for your comment! multiple interventions are necessary at a global scale to slow down the process of drug resistance. One of the important steps that must be taken in developing areas such as East-Africa, is the overall decrease of infectious diseases. Hygiene and sanitation must be improved, especially in health facilities. Prevention of infections and therefor prevention of antiviral or antibiotics, leads to an increased risk of the diseases becoming resistant to existing drugs.
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Hi guys,
A very interesting blog once again! Antimicrobial resistance is a very difficult problem arising all over the world. How is this problem related to your region? Is this problem comparable to the Western World or is the problem of AMR bigger/smaller than the Western World? Are the challenges the same or different maybe due to less variation in medicine in East Africa?
Keep it going!
Max Bakker
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Hi Max, thanks for your comment. In developing regions such as East-Africa, problems often lay in knowledge and education related issues. Drugs are often prescribed inappropriate due to lack of knowledge of the health care workers, and patients are often not well educated on how to use the drugs, and therefore they don’t use it correctly. These are specific factors that can be targeted by interventions in East-Africa, so no crucial mistakes are made due to ignorance.
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Dear group,
I found this blog post very interesting. Just like Lydia mentioned as well, I did not know that much about antiviral resistance and the size of this problem regarding HIV in in East-Africa. I also have one comment about the concept ‘underuse’ you mentioned. I think in all countries, not only in developing countries, people tend to quit their antibiotic course when they feel better. I think a main cause of antibiotic underuse in developing countries in contrast to developed countries, is that they may not have sufficient resources/medicines (or maybe even knowledge) resulting in use of left overs or a lack of availability of antibiotics.
I was also wondering how countries in East-Africa are doing concerning antibiotic stewardship; do they have rules/guidelines concerning this topic?
Kind regards,
Lisa
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