Dr. Robert Remis shared his findings Oct. 24 at Reseau Access Network's annual Opening Doors HIV/AIDS conference.
“What was particularly striking about our study, which was done starting in the fall of 2011, was that Greater Sudbury stood out as having a very, very high rate of resistance,” he said.
“Overall resistance was in the range of five to 15 per cent for Ontario as a whole, whereas in Sudbury, it was over 50 per cent.”
These HIV drug-resistant strains are most often found among injection drug users, Remis said. He said he doesn't know for sure why this would be the case, but he does have a theory.
“We feel that probably what happened is there was one drug user who was actively injecting and taking his or her anti-HIV drugs only irregularly,” Remis said.
“That's when drug resistance can emerge. That person may have had many needle-sharing partners, and somehow or another it was amplified very quickly.”
Given these drug-resistant strains of HIV, it's important to ensure those with HIV are on the right medications, he said.
When someone is diagnosed with HIV, they are subjected to a test called genotyping to see if they have a drug-resistant strain of the infection or not.
Roger Sandre, medical director of Health Sciences North's HAVEN program for those with HIV, said the standard of care is to determine which combination of medications will be most effective before treating any HIV patient.
“We always assess whether their strain of HIV is resistant to any of the medications, and we prescribe accordingly,” he said in a press release.
It's also important to do follow-up research on what's going on with HIV in Greater Sudbury, Remis said.
“We really need to nail down better exactly what's happening in terms of patterns of resistance.”
Beyond the issue of drug-resistant strains, there's also high HIV diagnosis rates in Sudbury.
“Toronto was the by far the highest, and Ottawa the second. Sudbury ranked sixth in the province of 36 health units,” Remis said.
“So it's on the high side. (HIV diagnosis rates are) 50 per cent higher (in Sudbury) than Thunder Bay and two to three times higher than the other five or six health units in the northern region.”
The proportion of injection drug users being diagnosed with HIV is 30 per cent in Greater Sudbury, compared to seven per cent in Ontario overall.
According to information provided by the health unit, a total of 120 cases of HIV infection were reported in the health unit's service areas from 2000 to 2010, with an overall average of 11 cases per year.
“I think it means that HIV continues to be an important problem in Sudbury, as it is everywhere else,” Remis said. “We need to think about primary prevention and take measures to ensure people don't get infected in the first place.”
Primary prevention includes better HIV testing, because those who know their HIV status are much less likely to transmit the infection.
It also includes providing clean needles and rehab programs for injection drug users and perhaps rethinking HIV prevention policies for men who have sex with men, as this population continues to have high HIV rates, Remis said.
“What we're doing doesn't seem to be working,” he said.
While HIV medications have greatly increased the life expectancy for those with the infection, they aren't an excuse to be complacent, Remis said.
Coupled with drug-resistant strains making it tricky to find the right medication, the drugs also have serious side-effects, he said.
“Overall, the longevity of people who are infected with HIV is much better than it was before these drugs were available, although still substantially shorter than they would be if not infected.”
Dr. Penny Sutcliffe, medical officer of health with the Sudbury and District Health Unit, said in a press release preventing HIV infection is extremely important.
“It's critical to practise safer sex, not share drugs and injection drug equipment and to know your and your partner's HIV status,” she said.
“Despite medical advances in treatment that can make HIV a chronic disease, it remains a huge personal and public health concern. Education and prevention, and early detection and treatment remain our focus.”
The health unit provides free and confidential counselling and testing for HIV. For more information, appointment times and locations, phone 705-522-9200 or visit www.sdhu.com.