The Nation (Nairobi)

15 December 2009

Kenya: Aids Drug to Be Withdrawn

Nairobi — An Aids drug that causes adverse side-effects in patients will be phased out in the next three years.

The number of patients on ARVs is also expected to double from the current 320,000 to almost 650,000 within the same duration.

The director of medical services, Dr Francis Kimani, on Tuesday said the withdrawal of Stavudine would be gradual. It will be replaced with two other drugs, AZT and TDF, which are known to be more effective and less toxic.

"Though the initial cost will be expensive, we expect to reduce on the progression of the disease and hope to manage opportunistic diseases early enough before they weaken the immune system," Dr Kimani told journalists at Afya House, Nairobi.

Staduvine currently costs Sh7,000 per patient annually compared to AZT and TDF, which cost Sh11,000 and Sh17,000 respectively.

Dr Kimani said the government would work on a plan to replace the drug and revise the national guidelines in line with the World Health Organisation recommendations.

"Of the 320,000 patients on ARVs, 70 per cent are on the drug (Staduvine) but we will ensure all are placed on the new regiments," said Nascop's treatment and Care head Ibrahim Mohammed.

At the end of 2008, 33.4 million people worldwide were living with HIV. Of these, 9.5 million were eligible for Anti-Retrovial Therapy (ART).

If the new proposals are implemented, WHO estimates that an additional three to five million people will be eligible for treatment.

"Initiating ART early rebuilds a person's immune system and the patient is less likely to develop TB thereby reducing death rates," Dr Kimani said.

Health centres and other organisations mandated to distribute the life-prolonging drugs were asked to monitor patients currently on Stavudine for two years to detect potential side-effects and consider changing to another drug where necessary.

Studies have shown Stavudine causes loss of body fat and a nerve disorder that leads to numbness and burning pain. Lactic acidosis, a condition caused by the build-up of lactic acid in the body when the liver or kidney are unable to shed off the excess acid, is another side-effect attributed to the drug.

Stavudine is marketed as Zerit by Bristol-Myers Squibb Co. It also available in various generic forms made in India.

Doctors fear that while the shift from Stavudine to less toxic drugs would benefit patients, it might present another problem: Shortages of drugs being experienced now may worsen as government struggles to supply the expensive regimen, resulting in treatment interruptions.

Though the number of patients who have experienced the side effects is not available, Dr Mohammed estimates that 20 per cent of patients suffer from them.

Other new guidelines expected to be introduced include a proposal to raise the cut-off of beginning ARVs from the current CD4 count of 250 to 350, a strategy aimed at reducing the progression of the disease.

CD4 count is a marker of likely disease progression. Initially in HIV infection there is a sharp drop in the CD4 count, as the immune system is damaged by HIV.

The greatest challenges the government faces are a rapid increase in new infections annually and the delay in buying crucial drugs.

The Global Fund's Review Board has recommended rejection of Kenya's request for Sh23.4 billion ($300 million) for HIV and Aids programmes, a move that could see hundreds of thousands of patients suffer unless the government and donors step in and find alternative ways to raise the money.

The board cited mismanagement of past allocations and wrangles between the ministries of Medical Services and Public Health as the reasons behind its decision to withhold the money.

Dr Kimani allayed fears of a drug shortage, saying, the current stock would be enough until February when another consignment was expected. He also said the government would boost prevention programmes to reduce new infections.

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