Ministry introduces HIV drug with few side effects

PIC: The new drug has fewer side-effects and will therefore improve adherence among people living with HIV

HEALTH

KAMPALA - The Ministry of Health said it has reached a decision to phase out adult first-line HIV treatment combination TLE (tenofovir-lamivudine-efavirenz) in favour of the more effective medication that contains dolutegravir — TLD.

TLD or tenofovir-lamivudine-dolutegravir is also more tolerable, with fewer side effects.

Dr Joshua Musinguzi, the AIDS control programme manager at the ministry, said on Tuesday: "We are changing our adult preferred first line ARV from TLE to TLD beginning July."

"TLD is superior in suppressing the HIV virus and has a higher resistance barrier," said Musinguzi.

Like TLE, TLD is a fixed dose combination medication for treatment of HIV/AIDS. But it is a smaller tablet compared with TLE, combining the three ARV drugs, which clients swallow once a day.

"The decision has been endorsed at the highest level of the top management and by partners supporting Uganda's HIV programmes, including the US (President's Emergency Plan for AIDS Relief) and Global Fund," said Musinguzi.

According to the health ministry data, approximately 1.3 million who are living with HIV in Uganda country take ARVs, with about 96% of them on first-line regimen and less than 4% on second-line. Others on third-line.

"The challenge has been dealing with the numbers which were increasingly developing resistance to first-line drugs, prompting medics to move them to second-line. Dolutegravir is less prone to resistance," Musinguzi said.

It is even cheaper (compared with TLE) — about $6.50 a dose a month — and plays well into the sequence needed to end AIDS by 2030: adherence, viral suppression, zero new HIV infections and zero AIDS-related deaths, he said.

The science is that persons living with HIV, who have achieved viral load suppression (VLS) live longer healthier lives and are less likely to infect their sexual partners or to transmit the virus to their unborn babies and TLD blends well in aiding adherence and viral load suppression.

Before the decision, the ministry conducted a pilot, introducing the new treatment combination to clients at selected HIV clinics. Musinguzi said the results were "awesome."

"TLD will be eased-in slowly, mainly given to new clients, as we phase out stocks of TLE. We shall not lose any drugs," Musinguzi said.

"We are adjusting our guidelines for HIV treatment and at the turn of the new financial year shall train health workers and medical personnel at districts about the new treatment combination. All our partners are on board. We shall continue to procure medication on time so we prevent cases of stock outs," he said.

Of course, the decision is not without consequences.

And Cipla Quality Chemical Industries Ltd, which invested in the one-pill-a day Trioday (also combining Tenofovir - Lamivudine - Efavirenz) in 2014, should be the most concerned.

But chief executive officer Emmanuel Katongole was optimistic the switch would not greatly affect operations of the pharmaceutical plant.

"The equipment is the same. It is a matter of getting in raw materials and getting registration from National Drug Authority and we start making the combination," said Katongole.

AIDS Activist Barbara Kemigisa welcomed the impending switch, saying new improvements in ARVs would contribute to the quality of life of persons living with HIV.

"ARVs with few side effects can only improve adherence and quality of life of clients," she said.

The Uganda Population HIV Impact Assessment (UPHIA) 2016 indicated the country made ‘tremendous progress' in the fight against infectious HIV since 2011 and  in a way, insinuated the first real possibility for the country to meet the global target of ending AIDS by 2030.

The report showed that the total population living with the virus dropped to 1.3 million in 2016, compared to over 1.6 million five years ago. It also showed that close to 60% of persons on ARVs achieved viral suppression.  The prevalence was estimated at 6.0%.