Kamela L Mahlakwane: ARV shortages – a weapon of mass destruction
The tragedy of antiretroviral shortages is that while we await the powers that be to implement contingency plans in resolving this issue, the virus (HIV) is busy remodelling itself to resist the drugs. As the levels of ARVs in the patients’ blood diminish, the virus gets fertile grounds to emerge resistant to the medications. The emergence of these drug-resistant HIV strains will surely rubbish all the good work done by the ARVs Roll Out programmes.
South Africa remains the leading country as far as HIV prevalence is concerned. This year it is estimated that around 7.52-million South Africans are living with HIV, as reported by Statistics SA. While this remains unpalatable news, the good news is that South Africa has managed to roll out the best ARV programmes in the world. The “Universal HIV Test-&-Treat” programme has ensured that people living with HIV get the life-saving ARV’s as early as possible. This has led to improved life-expectancy among this population. The UNAIDS 90-90-90 strategy calls for all the countries to ensure that, by year 2020, at least 90% of people living with HIV are diagnosed, 90% of the diagnosed people are taking the ARV’s, and of those taking ARV’s, 90% have HIV viral load that is so low to the levels that are not even detectable by our current laboratory tests. With our current ARV programmes, I have no doubt in my mind that we are moving in the right direction. Unfortunately, the news has broken that many state facilities are running short of these life-saving drugs. Many patients have already reported being sent back home from public ARV clinics, with no ARVs in hand. For obvious reasons, private health sector ARV stocks are still fairly intact. This, partly because there are very few clients in private sector compared to the public sector, and secondly because the drugs cost an arm and a leg. The tragedy of this unfolding story is that, while we await the powers that be to implement contingency plans in resolving this issue, the virus (HIV) is busy remodelling itself to resist the drugs. As the levels of ARVs in the patients’ blood diminish, the virus gets fertile grounds to emerge resistant to the medications. The emergence of these drug-resistant HIV strains will surely rubbish all the good work done by the ARVs Roll Out programmes. While it is very easy to treat the “normal” drug-sensitive HIV infection with first-line regimen drugs (what is now known as Fixed-dose combination/ FDC/ once-daily pill), it gets even more difficult to treat the drug-resistant virus. The most common cause of HIV drug resistance is “too little ARV levels in the blood”, caused by non-adherence or ARV shortages. Second-line regimen is fairly accessible for those patients who developed resistance to first-line regimen. However, the side effects thereof get even more, and the number of pills taken also increases. Unfortunately, we have plenty of patients already on this regimen. Scarily, access to third-line regimen is a nightmare. There is so much red tape, from paper work, to third-line committees, to costs of laboratory HIV drug-resistance testing, to availability of drugs, to side effects. But with these new ARV stock outs, patients are bound to develop HIV drug resistance. And if the powers that be do not act swiftly, this shall be a weapon of mass destructions, and worst still, a biological warfare against the poor. DM Dr Kamela L Mahlakwane is a Medical Virology Registrar at Stellenbosch University.