Reduced pill burden in HIV treatment

From the early 90s to present, new formulations and combinations of medications were approved to reduce pill burden in HIV treatment.

With the advancement of technology, and so is the evolution of HIV treatment.

Under study is the new HIV drug which is poised to further improve adherence on anti-retroviral drugs (ARVs) which will in turn reduce HIV-related deaths.

Instead of having to take a daily cocktail of medications to fight the virus, patients could just take a single capsule capable of delivering a week’s worth of treatment.

The capsule is a star-shaped structure with six arms that can be loaded with the drugs, folded inwards and encased in a smooth swallow-able coating. After the capsule is taken orally, the arms unfold and gradually release the drug.

With the help of Lyndra, the company helping to launch the technology, the team re-designed the capsule so it could deliver a combination of different drugs in each different arm.

Dr Giovanni Traverso, a research affiliate who worked on the new study said, “The ability to make doses less frequent stands to improve adherence and make a significant impact at the patient level. In a way, it’s like putting a pillbox in a capsule. Now you have chambers for every day of the week on a single capsule.”

One of the biggest obstacles currently facing attempts to reduce the numbers of HIV-related deaths worldwide is adherence to the strict drug schedule over a long period of time.

National Aids Council operations director, Mr Raymond Yekeye, concurred. “The less frequency of bill burden, the better the adherence,” he said.

In 2015, Government implemented the introduction of a single tablet a day ART therapy for people living with HIV as a measure to combat defaulting on the medication.

The once-a-day ART therapy is a combination of three drugs – Tenofovir, Lamivudine and Efavirenz (TLE).

This was a departure from the previous three-pronged tablets – Tenofovir, Lamivudine and Nevirapine (TLN) – which were taken separately, twice a day.

The overall worldwide mortality rate of HIV has dropped significantly since the introduction of anti-retroviral therapies (ART) in the 1990s, but there were still 2,1 million new infections and 1,2 million HIV-related deaths in 2015.

For the first time scales have tipped as HIV-related deaths have almost halved since 2005 globally.

In 2016, 19,5 million of the 36,7 million people living with HIV had access to treatment and Aids-related deaths have fallen from 1,9 million in 2005 to around one million in 2016.

As a result, life expectancy has increased significantly in the most affected countries.

However, there are reservations on the cost of the new HIV drug when introduced to the public.

The Permanent Secretary in the Ministry of Health and Child Care, Major-General (Rtd) Dr Gerald Gwinji, said the introduction of new drug(s) always has effect on cost.

“Initially when a new drug is introduced, it will cost more than what’s already there on the market but the price will eventually go down as more alternatives are introduced,” said Dr Gwinji.

So far the drug release formula has only been tested on pigs, and the tests showed that the capsules did work as planned.

And as a result, the researchers suggested that if it has the same effects in humans, the innovation could improve the efficacy of HIV preventative treatment by approximately 20 percent.

When this figure was incorporated into a computer model of HIV transmission in South Africa, the model showed that 200 000 to 800 000 new infections could be prevented over the next 20 years.

Researchers are currently working towards performing a clinical trial.

“Though the new drug is in the realm of research and until it’s proven that it actually works, it remains in that realm,” added Dr Gwinji.

In Zimbabwe, of the people living with HIV within the 15 to 64 years age group, 86 percent are currently on ART.

The country’s HIV prevalence rate has declined remarkably in recent years, dropping from as high as 24 to 14 percent, translating to approximately 1,4 million people living with HIV.

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