Drug-resistant HIV takes centre stage

Forward Nyanyiwa
Of late, Government has been making great strides in meeting the WHO 90-90-90 target which states that by 2020, 90 percent of the population should know their HIV status; 90 percent of those positive should be on ART and 90 percent of those on ART, should have viral suppression.

For James Diamond (49) (pictured)of St Mary’s in Chitungwiza, getting initiated on the life-saving anti-retroviral drugs was a blessing as he had gone through the cumbersome and expensive tests as far back as 2010.

He religiously followed the wise counsel he got from health workers to take his medication until a “silly” mistake occurred that has proven very costly for him.or James Diamond (49) (pictured)of St Mary’s in Chitungwiza, getting initiated on the life-saving anti-retroviral drugs was a blessing as he had gone through the cumbersome and expensive tests as far back as 2010.

“One was supposed to undergo a liver function test, full blood count and every other investigation as prescribed by the physician. There was also need for rigorous adherence counselling sessions in-between and it had to take the brave for one to ‘qualify’ for ART initiation.

“I had to patiently follow every step and I was glad when I got initiated on the programme. I knew, for a while, I had managed to ‘buy’ some time to look after my family,” he said.

Then that moment of madness came. Excited that he had recovered, Diamond decided to shelve his medication for the brown bottle. Things then turned nasty.

“I thought I had regained my health in entirety and foolishly I decided to stop taking my tablets. I had gone back to my former self and things seemed well until I started to feel sick again.

“Within weeks, I had lost considerable weight and I became bed-ridden. My subsequent visits to the hospital saw me being counselled and getting back to ART, but I did not improve. My condition worsened,” he narrated in a low tone.

Several tests were performed but that did not produce fruitful results and the sad truth began to unfold. “I was told I had become resistant to the available medication and I had to be put on second-line treatment.

“I became devastated. To this day, I am taking Abacovir and Atazanivir but time and again, they are in short supply and expensive to buy,” he said.

Diamond is not alone in this predicament as several Zimbabweans have had to endure the same fate, either by default or otherwise, and chances are high that the strain is spreading.

Government is currently having sleepless nights over the drug-resistant HIV strain as evidenced by the recent pronouncements by Health and Child Care Minister Dr David Parirenyatwa.

Dr Parirenyatwa admitted this resistance may have come at the wrong time and has obviously sent shivers down the spines of many, particularly those living positively.

On the sidelines of the commemorations of the World Breastfeeding Week held in Harare recently, the minister said Government was aware that 35 percent of people on ARVs in Zimbabwe were on second-line treatment either because they are not recovering on the first line, or they were reacting to treatment.

Said Dr Parirenyatwa: “We are now aware that 35 percent of our people are on second-line drugs which means there is some resistance. It is, however, not always resistance that they are put on second line, sometimes you just react to first-line drugs.”

Dr Parirenyatwa’s remarks came hot on the heels of the 2017 World Health Organisation HIV drug resistance report which indicated that two of 30 HIV-positive people on ART have shown signs of resistance to commonly used and affordable drugs.

Zimbabwe, like many other countries reeling from the scourge of HIV and Aids, has made significant strides in fighting the once deadly disease.

Deaths caused by the disease had commendably gone down in recent years, with a 38 percent reduction according to the last published report, as compared to the late ‘80s and early 90s when it claimed thousands of lives.

Of late, Government has been making great strides in meeting the WHO 90-90-90 target which states that by 2020, 90 percent of the population should know their HIV status; 90 percent of those positive should be on ART and 90 percent of those on ART, should have viral suppression.

While efforts are being made to meet the desired targets, the question that arises is whether we are now fighting another new HIV scourge.

Dr Cleophas Chimbetete, an HIV and Aids expert and analyst, said poor adherence was the Achilles heel.

“Our major problem has been that of poor adherence and compliance to medicines. People must be told of the importance of taking drugs religiously and more emphasis must be put to adolescents and young adults (10-24 years) because they are the most affected,” he said.

Another medical expert, Dr Justin Dambaza, said there are various causes besides poor adherence and there is need to closely monitor patients.

“Poor drug absorption in the bloodstream can result in decreased amounts of the medicine in the body thereby giving the HIV virus a chance to mutate and reproduce itself.

“If this then happens together with poor drug compliance, drug-resistant HIV can emerge even in the presence of the anti-retroviral drugs, so there is need to monitor patients,” said Dr Dambaza.

The consequences of drug-resistant HIV include treatment failure and further spread of drug-resistant HIV. This can then compromise the effectiveness of the limited therapeutic options to reach the last 90 target (of achieving viral suppression).

Former Health Deputy Minister Dr Edwin Muguti said there should be measures to mitigate the effects of the HIV drug-resistant strain.

“Surely, it is worrisome to have such a scenario when we have made major strides in fighting the Aids pandemic but this should be expected. When we have a polarised society filled with issues like stigma and denial, we should expect some resistance though on a smaller scale.

“We should then put up measures to educate our patients on the importance of taking up their medication religiously and the importance of having viral load tests. The issue of treatment buddies should be hammered home,” said Dr Muguti.

He said the 90-90-90 target can be affected but with minimal impact. “Given the work that has been done to reach the 90-90-90 target, I can say it will be foolhardy to suggest that there can be a major threat. Of course, we are saying every patient on ART should have viral suppression but how many will miss out on that target?

“In fact, we should be worried on how we can combat the situation before it goes out of hand. National health education campaigns should help us on this one.”

Mr Fungai Sinaro, an HIV activist, said it was also worrying that there are some people who are still in the murky waters of stigma today, and bemoaned the lack of serious support groups.

“I have been living positively for over a decade and I believe if all of us do away with stigma, compliance will be 100 percent.

‘‘This drug-resistant strain is not good at all because it will be like we are going one step ahead and two steps backwards. Let’s revive vibrant support groups whose primary goal would be to health educate participants not these co-operatives we are seeing today,” he lamented.

Dr Chimbetete said there is going to be a serious threat to the 90-90-90 target because of the resistant HIV strain.

“HIV drug resistance will impact on the third 90 because patients with resistance to the virus will fail to achieve suppression,” he said.

Dr Chimbetete was of the view that the quality of HIV treatment should be improved and drugs be available all the time.

“Let us improve the quality of our HIV treatment programmes and ensure that drugs are available all the time. There is also need to improve the availability of viral load testing for early diagnosis of those failing treatment and the training of health care workers.”

He suggested a national survey to assess the impact.

“We must have national surveys to assess the burden of HIV drug resistance and respond accordingly. Doctors should be equipped with more resources to check for resistance because the current costs are prohibitive.”

Director of Aids and TB in the Health Ministry Dr Owen Mugurungi said they were yet to get the WHO report, but Government would respond accordingly.

“I am yet to get the report but I think it is not that serious and as soon we see the report, the Ministry will respond to the situation accordingly,” he said.

According to the WHO 2017 HIV drug report, Zimbabwe is among six countries out of 11 from Africa, Asia, Latin America surveyed between 2014 and 2016 whose data showed an increasing trend of this new strain.

The other five countries are Namibia, Uganda, Nicaragua, Argentina and Guatemala.