The majority of the 42 367 HIV-positive people getting ARV drugs via the public sector would be dead by now if they did not take the drugs, according to several doctors treating patients on a daily basis.
This is despite concern expressed last week by Health minister Dr Manto Tshabalala-Msimang about the jump in patient numbers, saying she would investigate how many had experienced side-effects, dropped out or died while taking the drugs.
University of Cape Town’s (UCT) Professor Robin Wood believes that at least 700 of his 1000 patients would have died in the absence of the ARV treatment.
‘Less than seven percent of patients died on treatment in the past two and half years and their deaths were by far and away due to Aids-related conditions. Less than one percent of deaths were due to side-effects from the drugs,’ said Wood, co-director of the Desmond Tutu HIV Centre at UCT.
The Desmond Tutu HIV Centre provides ARV therapy to public sector patients in Guguletu and Masiphumelele as well as the trials unit in the Institute of Infectious Diseases and Molecular Medicine at the university.
The ARV clinic at Guguletu has 500 patients on treatment and a viral suppression rate of 87% for those patients on treatment for more than one year.
Wood confirmed that 10 percent of early deaths were due to immune reconstitution. Immune reconstitution is when a disease that was previously ‘masked’ is unmasked as the patient gets better on treatment.
Reacting to the Health minister’s comments, Wood said: ‘HIV is a lethal disease. All drugs have some toxicity. However the toxicity of these drugs (ARVs) is very low indeed.’
Detailed data from Khayelitsha in the Western Cape, published in the AIDS Journal last year, revealed survival and adherence data comparable to many settings in Europe and North America.
By the end of last year, 1 731 adults had been treated with ARVs in Khayelitsha and 165 (9,5%) of these patients had died.
Khayelitsha doctor Andrew Boulle confirmed that the majority of deaths were due to HIV-associated illness. ‘Rarely could the deaths be linked to side-effects of ARV drugs. In four patients there was evidence that drug toxicity was a contributing cause of death,’ he said.
‘Without ARVs, almost all of these patients would have die within three years,’ he added.
About 3 000 patients are on ARVs at Helen Joseph Hospital in Johannesburg. Dr Francesca Conradie was unable to give exact figures on how many patients had side effects, but said that most were minor with between five and 10 percent having to change their initial regimen.
The most prevalent side-effect reported by Conradie was peripheral neuropathy, where the patient experiences pain or numbness, usually in the feet and legs.
Conradie confirmed that some of side-effects could be severe, with the patient dying, but added there was no comparison when considering the mortality rate of HIV.
By the end of last year, the Free State had treated 509 patients with ARVs, and 473 (92,9%) were still receiving treatment. Twenty two (4,3%) had died and only four had been lost to follow-up.
However, 95 patients died before they could start ARVs. More than half the patients who died (including those on treatment) had CD4 counts of less than 50.
Only three patients had to change their regimen due to side-effects.
The biggest challenge was not side-effects and deaths, but the interruptions in drug supplies, limiting the number of patients who could safely be started on treatment.
Dr Fareed Abdullah is heading the treatment programme of over 7 000 patients in the Western Cape public sector.
‘We don’t have routinely collected side-effect data, but we do know that the serious side-effect incidences are less than one percent. Minor side-effects are probably between 10 and 15 percent,’ said Abdullah.
‘From a public health sector point of view there is no contest on the importance of providing ARV therapy,’ he added.
E-mail Anso Thom