South Africa: AIDS treatment has come a long way…
…down to a single pill a day – January 2014: Anti-retroviral therapy (ART) for the treatment of AIDS has been the biggest medical success of all time and has prolonged more lives than any other intervention in medical history, including polio vaccinations, says Dr Eric Hefer, member of the adult treatment guideline committee for the SA HIV Clinicians Society.1
ART is initiated in patients with AIDS with the goals of improving quality of life, reducing HIV-related morbidity and mortality, to optimally suppress viral load restoration and/or preserving immune function.2
These goals are achieved by suppressing the replication of the virus for as long as possible by using treatment that can be tolerated and sustained for an indefinite period of time. With prolonged viral suppression, the CD4 lymphocyte count usually progressively increases with the partial restoration of pathogen-specific immune function, dramatically reducing morbidity and mortality associated with HIV-infection. (Lymphocytes are a type of white blood cell. About 15 to 40 percent of white blood cells are lymphocytes and they are some of the most important cells in the immune system protecting a person from viral infections).2
ART consists of the combination of at least three antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease. Huge reductions have been seen in rates of death and suffering when use is made of a potent ARV regimen, particularly in the early stages of the disease. Increased access to ART can also reduce the HIV transmission at population level, impact orphanhood and keep families intact.3
Anti-retroviral therapy is known to have the following five benefits: 1) the medicines will increase the length of a person’s life; 2) improve the quality of a person’s life; 3) reduce the chance of a person getting nasty infections because of the weakened immune system; 4) boost the CD4 count and 5) reduce a person’s viral load.4
Antiretroviral therapy is a lifelong commitment and an individual needs to be mentally prepared to continue the lifelong process of antiretroviral therapy. In order for the medication to be effective, it is important that an individual takes his/her medication correctly. The medication must be taken every day as prescribed. If the prescribed treatment is not adhered to, resistance to the therapy emerges and the drugs become ineffective in treating HIV. Anti-retroviral therapy can also be used to prevent mother to child transmission of HIV as secondary infections, as prophylaxis in rape survivors and in medical professionals when a needle stick injury occurs.4
More than 30 years after the first incidences of AIDS, Minister of Health, Dr Aaron Motsoaledi, in a pioneering step, announced late in 2012 that fixed-dose combination (FDC) ARVs (anti-retroviral drugs) will be used in the first line treatment of HIV-positive patients from 1 April 2013 simply: “…because it’s simpler, more effective and cheaper than the current regimen.”5
The National Department of Health (NDoH) has made a commitment to rolling out FDC ARVs because it believes that they have a major benefit to people living with HIV in South Africa. There have been challenges with stock outs, but in fact, in the long run FDC ARVs will make procurement and supply chain management easier.5
“We need all leadership across South African society to mobilise communities to help us to address the challenges in the health system. For instance, we need everyone – civil society, traditional and community leadership, the faith-based sector and people living with HIV – to spread the word so that women book early for antenatal care and can benefit from FDC ARVs. This will make the difference,” said Motsoaledi.5
Minister Motsoaledi’s announcement about the introduction and phasing in of FDC ARVs was widely hailed because it is more convenient, easier to take and with fewer side effects. The patient will also have to undergo fewer laboratory tests once he/she is on treatment. As a result of all of these benefits, it is expected that adherence to ARVs will improve.5
Like many of his colleagues, Dr Hefer is particularly excited about the introduction and roll-out of FDC ARVs in both the private and public sector as it’s expected to encourage patients to remain compliant, thus saving the lives of more people living with HIV/AIDS.1
“Because the FDC ARVs comprise a single tablet, they should lead to improved compliance and this is why we’re actively supporting treatment. Besides, it just makes everybody more comfortable – from the prescriber and the dispenser to the patient – that the latter will actually be taking the medication. At the same time, it diminishes the risk of stock outs,” says Dr Hefer.1
The Treatment Action Campaign (TAC) likewise welcomed government’s announcement of the FDC ARV roll-out, stating that: “the benefits of FDC ARVs extend beyond patients to health workers and health systems. FDC ARVs will make prescribing, dispensing and monitoring treatment easier for nurses and pharmacists. They will also simplify procurement and supply chain management. This is particularly important given the ongoing challenges with medicines supply, leading to shortages and stock-outs of ARVs and other critical medicines.”6
Earlier this year, SANAC CEO Dr Fareed Abdullah also welcomed the roll-out of FDC ARVs, saying that it would simplify the way patients take ARV treatment. “This simplification of treatment makes taking AIDS treatment convenient. We hope that it will result in patients complying with and adhering to their treatment, and will enable many more patients to take their medication everywhere and anywhere they may be. We have come a very long way since the advent of ARVs. At one point, patients used to take up to 16 pills a day,” said Dr Abdullah.7
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References:
- Dr E Hefer. Information supplied in response to interview 04-12-2013.
Dr Hefer is, among other things, advisor to Umvuza Medical Aid and Calibre Clinical Consultants and member of the adult treatment guideline committee for the SA HIV Clinicians Society.
- Southern African HIV Clinicians Society – Guidelines for Antiretroviral therapy in adults. [Online]. 20 September 2012 [cited 2014 Jan 16]. Available at: URL:http://www.sahivsoc.org/practise-guidelines/sa-hiv-clinicians-society-guidelines
- World Health Organisation: HIV/AIDS: Antiretroviral Therapy. [Online]. 2014 [cited 2014 Jan 16]. Available at: URL:http://www.who.int/hiv/topics/treatment/en/index.html
- Adcock Ingram website: About us: Anti-retroviral portfolio. Available at: http://www.adcock.co.za
- Government of South Africa. Fixed-dose combination ARVs: Everything you need to know. One ARV Pill a Day. [Online]. 2013 [cited 2014 Jan 16]. Available at: URL:http://www.sanews.gov.za/special-features-archive/fixed-dose-combination-arvs-everything-you-need-to-know
- Treatment Action Campaign (TAC). TAC welcomes the inclusion of fixed-dose combination medicines in the 2013-2014 antiretroviral medicines tender. Submitted by administrator on Thu, 2012-11-29 21:47. Available at: http://www.tac.org.za/news/tac-welcomes-inclusion-fixed-dose-combination-medicines-2013-2014-antiretroviral-medicines
- SANAC welcomes fixed dose combination ARVs – 8 April 2013). [Online] [cited 2014 Jan 16]. Available at:URL:http://www.sanews.gov.za/sanac-welcomes-fixed-dose-combination-arvs
