Health-e (Cape Town)

2 December 2012

South Africa: Simplifying Aids Treatment

This past week the national Health Department announced that as from April 2013, AIDS patients will start taking one antiretroviral pill a day that combines the compounds of all three ARVs they need for effective treatment. This has been lauded as making AIDS treatment simple and convenient.

Gone will be the days when AIDS patients will have to sort through a combination of pills every day – morning, day and evening – to control their HIV infection. As from April next year, patients will have the convenience of taking just one pill a day, which contains all three antiretroviral drugs that they need. Scientists and doctors call it a “fixed dose combination” – packaged in a single tablet.

“Tenofovir, Efavirenz, Emtricitabine – all combined in one tablet. This, in very simple language, means that a patient doesn’t have to take three tablets three times a day. A patient is going to take one tablet once a day”, says national Health Minister, Dr Aaron Motsoaledi.

Motsoaledi says the fixed dose combination therapy will have positive spin-offs for patient outcomes.

“We believe that this a major benefit in terms of compliance. It also means that logistics and storage are reduced. Additionally, it also means fewer side-effects that patients will experience”, he says.

The president of the Southern African HIV Clinicians’ Society, Dr Francesca Conradie, said this was making AIDS treatment simple.

“What’s been announced is the simplification of the programme. One tablet a day! It used to be 16 tablets a day around the year 2000. We have come a very, very far way and, logistically, it’s simpler for the patient, the pharmacist and the health care system”, she said.

Health Minister, Dr Aaron Motsoaledi, says at the beginning of next April, the majority of the 1.7 million patients who are on AIDS treatment – over 80% - will move onto the new fixed dose combination therapy. A few that can’t switch will continue with the current multiple pills regimen.

“The majority of patients on three ARV drugs will be able to be switched to the fixed dose combination. It’s not everybody who will be switched to the fixed dose combination. But the majority – more than 80% of our patients will go to the fixed dose combination. For those who cannot be switched for one reason or the other - because their clinicians may decide that it’s not clinically wise – (it) means some will still go on the old treatment regimen. For those, we will still keep the individual ARV drugs as well”.

He added that the same fixed dose combination therapy will also apply to pregnant women, thus replacing the current regimen of using a combination of two drugs, Nevirapine and AZT.

“All pregnant women in South Africa, during pregnancy and the whole period of breast-feeding, will receive this fixed dose combination regardless of their CD 4 count. Once you’re pregnant and positive, right from the pregnancy until you finish breast-feeding, we will put them on this single dose combination. And we will continue even after breast-feeding if their CD 4 count falls below 350.

We believe this intervention will protect more babies and will also protect the mothers. The fixed dose combination is more effective than dual therapy for pregnant women and it has got fewer side-effects for pregnant mothers in addition to its convenience on dosage”, Motsoaledi explained.

According to Dr Francesca Conradie, the new regimen is the way to go if the country wants to have zero HIV infections of newborn babies. She also allayed fears that giving a triple combination prophylaxis to pregnant women who have very high CD 4 counts might pose some threat.

“We’re actually looking at two things. We’re looking at making sure the mom is safe and that we can deliver a healthy, negative baby. The best way to get a healthy, negative baby is to not allow that baby to see any virus in the mother’s blood stream and the only way to do that is with effective antiretroviral therapy. If we give antiretroviral therapy at a high CD 4 count, it certainly does no harm. It doesn’t do as much good as if you give it to someone with a CD 4 count of 100, but it certainly does some good. And to extend that cover right through breast-feeding is the way we’re going to get to zero new infant infections and we will not be harming moms in any way”, Conradie said.

The new regimen is in line with the World Health Organisation’s recommendations.

“The WHO had already recommended a combination prevention, alongside a comprehensive access to treatment was likely to get us the best outcomes for both mothers and babies. Sensibly, the government has decided that a shift to combination prophylaxis for all pregnant women through the breast-feeding period is likely to represent for us at this time an approach that will allow us to address the gaps that we see. We’re seeing huge improvements in the infection rates in babies. We’re seeing a decline in mothers dying. We’re seeing all sorts of the signs in the right way. But the problems we see with the programme seem likely to be improved by the switch to this combination prevention”, said Dr Siobhan Crowley of the United Nations’ Children’s Fund (UNICEF) in South Africa.

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