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Too Many AIDS Patients, Too Few Drugs


The HIV/AIDS pandemic began in Africa and the continent is home to most of the people living with the disease. But Africa has been among the last regions to receive the medicines needed to fight it. What’s more, the arsenal of available drugs is very limited. One medical NGO is trying dealing with the problem.

Most of the estimated 40 million people living with HIV/AIDS are in Africa. One of the countries hardest hit has been South Africa, with a reported 5.3 million people infected with the AIDS virus. About 70,000 of them live in Khayelitsha, a town half a half hour’s drive from Cape Town. That’s where the humanitarian group Doctors without Borders relies on anti-retroviral drugs to keep many of them alive.

Nathan Ford is the group’s country coordinator for its Access to Essential Medicines Campaign.

“We now have around five years of experience of treating HIV here and some of our original patients that we provided treatment to in the very early days are still on treatment. So, what we’re seeing here is what you would call the problem of an aging treatment cohort. You have patients who have been taking their first line of therapy now for quite a few years. And it’s only after a few years that certain problems start to arise,” he says.

Those problems include drug toxicity and drug resistance. Drug resistance means the medications no longer slow HIV from reproducing. Drug toxicity causes such things as nerve damage and lactic acid build-up. Lactic acidosis, once it’s established in a patient, has a mortality rate of 30 to 60 percent.

Ford, a virologist, says when that happens it’s time to change the patient’s drug cocktail, shifting from what’s called first line treatment to second line treatment.

He says, “Anti-retroviral therapy has to take a cocktail of three drugs normally. So, you’re talking about several different several different anti-retroviral medicines all put together to form a treatment.”

And that’s where the problem arises. When doctors in Khayelitsha look for a new combination to give their patients they don’t have nearly as many choices as do their counterparts in rich nations.

Ford says, “Clinicians in the developed world have the ability to adapt their treatment according to individual patients and are also able to switch drugs if patients suffer from relatively mild side effects. Now, the problem we face in Africa, and South Africa as much as anywhere else, is that we don’t really have a whole range of options, partly because the newer medicines are far to expensive for us to use or partly also because they made be offered at a more affordable price but they’re not registered for use in country.”

And when a drug is not registered, it’s very difficult to obtain due to bureaucratic obstacles. Ford says another problem is heat coupled with a lack of electricity in many areas. That makes storage of AIDS medicines difficult if not impossible. For example, Doctors without Borders has asked Abbott Laboratories to make a new version of a drug available at a low price because it does not require refrigeration.

Ford says more types of anti-retrovirals are needed now and in large quantities in South Africa.

“Both the rate of infection and the rate of mortality are very, very high. It’s estimated around 950 people die every day of HIV/AIDS in South Africa and 1500 new people are infected every day,” he says.

This August, the 16th International AIDS Conference will be held in Toronto, Canada. The theme – Time to Deliver – reflects the goal to provide treatment to all those in need.

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