A woman takes an HIV test. Adults register the most side-effects from ARVs

By Collins Vumina

A twitching in his left eye, shingle on the lower left side of the eye, a rash on the arms and early morning paralysis in the feet make Fred Kanyankore wonder what has befallen him.

He finds it hard to believe that the disturbing changes in his body are a result of the type of ARVs he is taking.

“I have been taking these drugs since 2006. They cannot cause these things now,” he says.

Kanyankore, a carpenter in Fort Portal town says these symptoms started about a month ago. He has come to Mbarara Hospital to see a doctor about the symptoms.

Teopista Kobugabe is also complaining about a swelling under the ear and her nails are discolored. “I look like I have mumps,” says Kobugabe. “I am sure someone is responsible for this. First it was the black nails and now the feet often get paralyzed in the mornings.

I think I walked over herbs that could be responsible for this. Whoever is bewitching me has hit the target because after someone has taken away your hands and feet, what can you do for yourself?” she says, fixing a blank gaze at the ceiling.

These are just two of many cases of side effects resulting from the arv drug option Triomune.

The Ministry of Health is aware of the side-effects and has instructed health facilities countrywide to phase out the drug.

Triomune is a fixed drug combination and one of its components, Nevirapine has been blamed for these side-effects.
Dr. Michael Owor of Joint Clinical Research Centre (JCRC) Fort Portal says the complaint rate is high.

At this branch, which has 6,500 patients, several clients have had side effects such as pencil legs, swelling of the cheeks and nail discoloration, excessive heating and feet paralysis.

However, Dr. Owor says nail discoloration is not only associated with Triomune.

“The children are still on Triomune and rarely present with these side-effects.
We are now giving those with complaints alternatives like Combivir and Atripla as the first lines of treatment,” he says.

But what has been the response after changing from Triomune to other options?
Dr Owor says: “The response is okay. For those changing to other drug options, the visible side effects like shingles are fading.

In three months or so, we will have finished transferring all our adult patients from Triomune,” Owori says. He says Mengo Hospital has finished shifting their patients.

Dr. Nasur Akbar, a medical officer in Yumbe Hospital says National Medical Stores stopped supplying them with Triomune.

“We are now getting Combivir as the first line of treatment.” Of the 600 HIV positive people registered with Yumbe Hospital, only 23 have been tranferred from Triomune.

This is because a number of the patients who have reacted to Triomune does not warrant a shift. “It is only when a patient presents with side-effects that we give alternatives.”

Triomune, according to Dr. Nasur, is good for patients with heamoglobin (HB) less than 8, instead of Combivir which has a component called Zidovudine or AZT, which can cause anemia. Heamoglobin is an iron-containing pigment that carries oxygen to to body tissue.

However, some doctors are sceptical about changing the drug regimes. Dr. Agaba Byamukama of Kasana in Luweero district says: “Some of these changes are unsustainable.

Remember the story of Chloroquin and Fansidar. The Government introduced Coartem as the first line of treatment against malaria and relegated the other two.

Now there is scarcity of Coartem in health facilities due to its high cost. Some reports are indicating that we may have a shortage of Combivir in the near future.”

However, the Ministry of Health says the supplies are sustainable. Despite the recent ARV scarcity, the Government says ARV supplies are now available.

The head of the antiretroviral therapy programme at the ministry, Dr. Elizabeth Namagala, says the drugs have already arrived in the National Medical Stores.

The general manager of the National Medical Stores, Moses Kamabale confirmed that ARVS and anti-malarials have been delivered to the National Medical Stores in Entebbe.