Posted by Professional Networkers on June 22, 2003 at 09:12:48:
Warning On Abuse of Antiretrovirals
Sunday Times (Johannesburg)
June 22, 2003
Nicki Padayachee
Johannesburg
HIV-positive patients who do not follow their antiretroviral treatment regimens correctly can cause more drug-resistant strains of the virus to develop, according to a report by the London School of Hygiene and Tropical Medicine published in the British Medical Journal.
The report found that:
Only 5% of the 5.5 million people who need antiretroviral treatment in developing countries receive it;
People who have sexually transmitted diseases prefer to be treated in the private rather than the public sector because of the stigma attached to these diseases. In Senegal, nine types of antiretroviral drugs were available in the informal private sector by 2002; and
Of 200 HIV-positive patients referred to specialist centres in India because of their poor response to antiretroviral treatment, 10% had adhered to the treatment, 50% had stopped taking the drugs on the advice of traditional healers and 80% had received incorrect doses.
The report cites the initiative of SA company Abbott Laboratories as an example of how governments and the private sector should administer antiretroviral treatments. Abbott's employees and their families receive a free HIV care package that includes antiretrovirals. They can consult a number of private doctors who are supported by a team of HIV/Aids specialists.
The report states that many medical practitioners in Zimbabwe and Uganda practise "therapeutic anarchy", using "any antiretroviral they can lay their hands on".
Changing prescriptions often and administering insufficient doses or only one type of drug is extremely dangerous, the report says.
Dr Glenda Gray, an Aids researcher at Soweto's Chris Hani Baragwanath Hospital, agreed that antiretrovirals could be dangerous if used incorrectly. She said drug-resistant strains of HIV could be transmitted from mother to child and between sexual partners, making it more difficult to treat Aids.
But Gray said she was concerned that health policymakers would use the study to justify their reluctance to roll out antiretroviral treatment to Aids patients. "Are we going to sacrifice four million South Africans because we are too worried about resistant strains, or are we going to rise to the occasion and make sure people are educated properly about how to take the drugs?" she asked.
Nathan Geffen of the Treatment Action Campaign said the report was the "most serious indictment yet of Health Minister Manto Tshabalala-Msimang's failure to implement antiretroviral treatment".
Geffen said Aids sufferers would do anything they could to save their lives, and that many were taking inadequate and irregular drug doses because that was all they could afford.
"The study backs up what we have been saying for years. As long as there is no proper public-sector antiretroviral programme, there will be antiretroviral chaos," he said.
Department of Health Director General, Dr Ayanda Ntsaluba, said that the report confirmed his department's stance on the rollout of antiretroviral drugs to Aids patients.
"It calls for greater responsibility. We are not arguing that there is no place for antiretrovirals, but it is important to understand the implications when they are rolled out in a manner that does not ensure optimal use, follow up checks and adherence to good protocols," he said.
Ntsaluba said that "if" government decided to administer anti-Aids drugs, the department of health would have to make sure that patients take them as prescribed and train health personnel on how to make sure this happens.
He said that a possible rollout of anti-Aids drugs would require additional support from patients' families, communities as well as civil society.
Ntsaluba said his department has made a "significant" investment in the public health infrastructure independent of the implementation of an antiretroviral programme.
But, he said, some provinces - like Gauteng, KwaZulu-Natal and the Western Cape - and their institutions would have better capacity to deal with the programme than others.
"Most of rural South Africa does not have that capacity and that is where the biggest concentration of desperate people lies," he said.
Tshabalala-Msimang - who caused an outcry when she said antiretrovirals could kill poor people and that a balanced diet was as effective in combating Aids as expensive drugs - was not available for comment.