**7. Global action plan, WHO**

WHO has documented that MDR-TB is emerging as a major challenge for tuberculosis control programs and is becoming extensively widespread today throughout the world, even in high-income countries with low TB incidence. Resistance to anti-TB drugs occurs due to misuse of drugs such as patients do not compete full course of treatment, wrong treatment provide by physicians, wrong dose or length of time for taking the drugs and supply of poor quality drugs. Multidrug-resistant TB is caused by *Mycobacterium tuberculosis* that is resistant to at least to two most potent TB drugs such as isoniazid and rifampicin. Extensively drugresistant TB (XDR-TB) is MTB resistant to isoniazid and rifampicin along with any fluoroquinolone and at least one of three injectable second-line drugs includes amikacin, kanamycin or capreomycin. Treatment options for XDR-TB have more side effects, and they are more expensive. XDR-TB can weaken the immune system, and persons are more likely to develop

In 2010, about 650,000 cases have MDR-TB, which account for 5% of all newly diagnosed TB patients, and more than 150,000 MDR-TB deaths are estimated to occur worldwide each year with case fatality rate of 30 per 100 individuals [59]. The proportion of MDR-TB reported globally ranges from 0 to 28.3% and 0 to 61.6% among new TB cases and among previously treated TB cases respectively [60]. People living with HIV are at a higher risk of developing MDR and XDR tuberculosis associated with increased mortality, and greatly reduced survival

The two multidisciplinary research teams such as RAND Europe and KPMG, have provided their own high-level assessments of the future impact of antimicrobial resistance, based on scenarios for rising drug resistance and economic growth to 2050. The studies estimate 300 million people are expected to die prematurely due to drug resistance over the next 35 years and the world's Gross Domestic Product (GDP) will be 2% to 3.5% lower than it otherwise would be in 2050. This means that between now and 2050, the world can expect to lose between 60 and 100 trillion USD worth of economic output if antimicrobial drug resistance is not tackled. This is equivalent to the loss of around 1 year's total global output over the period, and will create significant and widespread human suffering. Furthermore, in the nearer term, they expect the world's GDP to be 0.5% smaller by 2020 and 1.4% smaller by 2030 with more than

WHO developed a global priority of pathogens list (global PPL) of antibiotic-resistant bacteria to help in prioritizing the research and development (R&D) of new and effective antibiotic treatments. Drug-resistant bacteria were categorized into critical priority, high priority and

TB disease and they are at high risk of death.

**5. Future impact of antimicrobial resistance**

100 million people having died prematurely [62].

**6. Tackle of antimicrobial resistance**

medium priority pathogens (**Table 3**) [63].

time of patients [61] (**Table 2**).

94 Advances in HIV and AIDS Control

WHO developed the global action plan with five strategic objectives to achieve the goal of ensuring continuity of successful treatment and prevention of infectious diseases with effective and safe medicines [64]. They (1) improve the awareness and understanding of antimicrobial resistance through effective communication, education and training, (2) strengthen the knowledge and evidence base through surveillance and research, (3) reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures, (4) optimize the use of antimicrobial medicines in human and animal health and (5) develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.

#### **7.1. Examples for global impact of antimicrobial resistance research and interventions**

Examples of global research into antimicrobial resistance and its impact are given below [29]:


• Antimicrobial Resistance Monitoring and Research Programme (United States): Infections with carbapenem-resistant Enterobacteriaceae declined and there were no further reports of outbreaks of colistin-resistant *Acinetobacter* spp.

[3] World Health Organization. HIV and AIDS. 2018. Available from: http://www.who.int/

Drug-Resistant Bacterial Infections in HIV Patients http://dx.doi.org/10.5772/intechopen.78657 97

[4] US Department of Veteran Affairs. HIV and AIDS. 2018. Available from: https://www.

[5] Centers for Disease Control and Prevention. HIV transmission. Available from: https://t. cdc.gov/synd.aspx?js=0&rid=cs\_3605&url=http://t.cdc.gov/VIK [Accessed: May 05, 2018]

[6] Doitsh G, Galloway NL, Geng X, Yang Z, Monroe KM, Zepeda O, Hunt PW, Hatano H, Sowinski S, Muñoz-Arias I, Greene WC. Cell death by pyroptosis drives CD4 T-cell

[7] Deokar S, Badhankar MG. Studies on emergence of drug resistance in HIV associated bacterial urinary tract infections. American Journal of Infectious Diseases. 2009;**5**:183-187

[8] Cunningham AL, Donaghy H, Harman AN, Kim M, Turville SG. Manipulation of dendritic cell function by viruses. Current Opinion in Microbiology. 2010;**13**:524-529. DOI:

[9] Garg H, Mohl J, Joshi A. HIV-1 induced bystander apoptosis. Viruses. 2012;**4**:3020-3043.

[10] National AIDS Control Organisation. Guidelines for Prevention and Management of Common Opportunistic Infections/Malignancies Among HIV-Infected Adult and Ado-

[11] Jaspan HB, Huang LC, Cotton MF, Whitelaw A, Myer L. Bacterial disease and antimicrobial susceptibility patterns in HIV-infected, hospitalized children: A retrospective cohort

[12] Abraham M, De N, Sudi IY, Ma'ori L. Isolation of methicillin resistant *Staphylococcus aureus* (MRSA) from AIDS patients attending the state specialist hospital, Yola and Federal Medical Centre, Yola, Adamawa State, Nigeria. Report and Opinion. 2009;**1**:103-107

[13] Siegel JD, Rhinehart E, Jackson M, Chiarell L. Management of multidrug resistant organisms in healthcare settings. CDC. 2006;**2006**:1-74. DOI: 10.1016/j.ajic.2007.10.006

[14] Feikin DR, Feldman C, Schuchat A, Janoff EN. Global strategies to prevent bacterial pneumonia in adults with HIV disease. The Lancet Infectious Diseases. 2004;**4**:445-455. DOI:

[15] Department of Health and Human Services. AIDS Info. HIV and Opportunistic Infections, Coinfections, and Conditions. 2017. Available from: https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/26/86/what-is-an-opportunistic-infection [Accessed: April 12,

[16] Mayo Clinic. Pneumonia. 2018. Available from: https://www.mayoclinic.org/diseasesconditions/pneumonia/symptoms-causes/syc-20354204 [Accessed: April 12, 2018]

lescent. New Delhi: NACO, Government of India; 2007. p. 2

study. PLoS One. 2008;**3**:1-6. DOI: 10.1371/journal.pone.0003260

depletion in HIV-1 infection. Nature. 2014;**505**:509. DOI: 10.1038/nature12940

hiv.va.gov/patient/basics/how-HIV-spread.asp [Accessed: April 05, 2018]

news-room/fact-sheets/detail/hiv-aids [Accessed: April 05, 2018]

10.1016/j.mib.2010.06.002

DOI: 10.3390/v4113020

10.1016/S1473-3099(04)01060-6

2018]

• In the Netherlands, a decrease of CTX-M−1-1-like ESBL genes (from 44 to 25%) in livestock was seen during 2010–2014 due to >60% reduction in antibiotic use in livestock.
