Big step forward for Aids patients

THE new antiretrovirals South Africa will introduce next year are cheaper‚ have far fewer side effects than current drugs and HIV cannot develop resistance to them.

“It’s not often in medicine that we get something safer and more effective that is also cheaper. This is a big step forward‚” Wits Reproductive Health and HIV Institute deputy director Professor Francois Venter said.

In medicine‚ usually better drugs were more expensive‚ he said.

Last week‚ Bill Gates announced at a UN General Assembly that the drug would be scaled up by manufacturers at a capped price of $75 (R1 000) a year.

The Gates Foundation has given a financial assurance to drug manufacturers that the volumes needed for a low price would be bought.

South Africa offers three drugs in a single pill and one of the drugs – Efavirenz – will be replaced with the new drug‚ Dolutegravir‚ which has far fewer side effects.

Dolutegravir is used by HIV-positive patients in Europe and America.

Efavirenz‚ which is used locally‚ causes depression in some users as well as insomnia‚ nightmares and hallucinations. It can also cause severe liver damage in very rare cases.

Health department spokesman Joe Maila said: “Dolutegravir is well-tolerated by patients and has fewer side effects.

“Patients are therefore more likely to be adherent and more likely to be virally suppressed – which means that they are not likely to transmit the virus to others.”

South Africa has the largest HIV treatment programme in the world with the lowest-priced ARVs.

There was no way to manufacture the current treatment – which was sold at less than R90 a month per patient – any cheaper. The new drug is cheaper because fewer ingredients are used in it.

A cheaper price would be one way to scale up treatment available‚ from 3.9 million South Africans to about 6.5 million people who are HIV-positive.

It is the government’s policy that all positive people get treatment.

Because Dolutegravir is a drug that the virus does not become resistant to, fewer people will require more expensive ARV drugs due to resistance.

Venter said: “Dolutegravir has one of the highest resistance barriers we have ever seen – in over 600 000 people treated‚ we have only seen one patient become resistant and that was easily treated by adding another‚ very safe drug.”

In rare cases Efavirenz has caused fatal liver damage in a handful of patients on ARVs across South Africa. Hepatologist and UCT professor Mark Sonderup said he was pleased it was being phased out.

“The move to Dolutegravir is immensely positive and will negate the adverse effects of Efavirenz,” he said. – TimesLIVE