Over 90% of Human Immunodeficiency Virus (HIV) infected individuals will be on treatment by 2020 under UNAIDS 90–90-90 global targets. Under World Health Organisation (WHO) “Treat All” approach, this number will be approximately 36.4 million people with over 98% in low-income countries (LICs). Pretreatment drug resistance (PDR) largely driven by frequently use of non-nucleoside reverse transcriptase inhibitors (NNRTIs), efavirenz and nevirapine, has been increasing with roll-out of combined antiretroviral therapy (cART) with 29% annual increase in some LICs countries. PDR has exceeded 10% in most LICs which warrants change of first line regimen to more robust classes under WHO recommendations. If no change in regimens is enforced in LICs, it’s estimated that over 16% of total deaths, 9% of new infections, and 8% of total cART costs will be contributed by HIV drug resistance by 2030. Less than optimal adherence, and adverse side effects associated with currently available drug regimens, all pose a great threat to achievement of 90% viral suppression and elimination of AIDS as a public health threat by 2030. This calls for urgent introduction of policies that advocate for voluntary and compulsory drug licensing of new more potent drugs which should also emphasize universal access of these drugs to all individuals worldwide. The achievement of United Nations Programme on HIV and AIDS 2020 and 2030 targets in LICs depends on access to active cART with higher genetic barrier to drug resistance, better safety, and tolerability profiles. It’s also imperative to strengthen quality service delivery in terms of retention of patients to treatment, support for adherence to cART, patient follow up and adequate drug stocks to help achieve a free AIDS generation.

中文翻译：

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低收入国家迫切需要更有效的抗逆转录病毒疗法，以实现联合国艾滋病规划署 90-90-90 并在 2030 年之前彻底根除艾滋病

根据联合国艾滋病规划署 90-90-90 全球目标，到 2020 年，超过 90% 的人类免疫缺陷病毒 (HIV) 感染者将接受治疗。根据世界卫生组织 (WHO) 的“全部治疗”方法，这一数字将约为 3640 万人，其中 98% 以上来自低收入国家 (LIC)。治疗前耐药性 (PDR) 主要由非核苷类逆转录酶抑制剂 (NNRTIs)、依非韦伦和奈韦拉平的频繁使用驱动，随着联合抗逆转录病毒疗法 (cART) 的推出，一些低收入国家每年增加 29%。大多数低收入国家的 PDR 已超过 10%，这需要根据 WHO 的建议将一线治疗方案更改为更强大的类别。如果 LICs 不强制改变治疗方案，估计超过 16% 的总死亡人数，9% 的新感染，到 2030 年，艾滋病毒耐药性将占总 cART 成本的 8%。依从性不佳，以及与目前可用的药物治疗方案相关的不良副作用，都对实现 90% 的病毒抑制和消除艾滋病构成了巨大威胁，因为到 2030 年将成为公共卫生威胁。这需要紧急出台政策，提倡自愿和强制对新的更有效药物进行药物许可，同时还应强调这些药物对全世界所有人的普遍可及性。联合国艾滋病毒和艾滋病规划署 2020 年和 2030 年目标在低收入国家的实现取决于获得具有更高耐药性遗传屏障、更好的安全性和耐受性的主动 cART。在留住患者接受治疗方面，还必须加强优质服务的提供，