On the occasion of World Aids Day, South African health minister Zweli Mkhize announced the roll-out of a new state-of-the-art antiretroviral drug which, he said, should drastically reduce the number of people living with HIV.
The roll-out could start as soon as this month. A modified three-in-one pill was hailed as a ‘game-changer’, much needed in South Africa where 7.7 million South Africans are living with HIV.
Minister Mkhize called it “the fastest way to reduce HIV viral load”. The new pill is said to be easier to take than other formulations. However one of the main ingredients, Dolutegravir, could have serious side effects.
“The government has a very ambitious plan,” said Robert Matiru of the global health body UNITAD, “of switching the 4.8 million South Africans who are currently on the older regimen of HIV treatment onto this new regimen by 2021, in addition to getting the remaining 3 million people who are not currently on HIV treatment on to this regimen by then as well. It’s a massive undertaking to put in place,” he acknowledged, while adding “it’s a really welcome move for the people of South Africa.”
Matiru said savings created by transferring those already receiving antiretrovirals (ARVs) to the new, cheaper regimen could allow up to 5 million more people to receive treatment.
But the wisdom of changing drugs mid-stream was questioned by infectious disease specialist Graeme Meintjes, one of a consortium of scientists, regulators, drug companies, donors and advocates on the issue.
Referring to Efavirenz, one part of a three in one formula now slated to be discontinued, the group called ‘Optimize’ wrote: “Efvirenz has served us VERY well (uppercase his). “In TB, pregnancy and in the field.”
Switching from one formula to another raises several issues: millions will need to be switched – a huge undertaking, the benefit of one drug over another is “unlikely to be a big deal.” Training? Pregnancy? (limited data), TB? (Studies are needed), Studies largely done on men. Side effects?
More disturbingly, the new addition to the drug cocktail – Dolutegravir – presents serious side effects for some patients, according to AIDSinfo, a web page of the U.S. Dept. of Health and Human Services. These include life-threatening side effects such as allergic (hypersensitivity) reactions and liver problems especially for those with a history of hepatitis B or hepatitis C virus infection. Also, trouble sleeping, tiredness, and headache, which are among the most common side effects
Meanwhile, Rwanda is set to begin trials with an HIV injection drug, which is regarded as a more improved and sustainable way of treatment, according to the head of the Rwanda Biomedical Centre as reported by the Chinese news agency CGTN.
If the drug successfully completes its trial, it means that HIV patients on antiretroviral drugs will no longer have to take drugs on a daily basis but they will need injection boosters every 8 weeks.