Ayanda Mahlangu from Daveyton east of Johannesburg has been without one of her three ARVs for a week as her local Daveyton East and Daveyton Extension clinics run dry of the ARV lamivudine.

“I haven’t been taking treatment for a week now,” Mahlangu said. “They (nurses) did not even give me alternatives. They said I must wait until lamivudine becomes available.”

Because ARVs must always be taken in three to prevent the development of drug resistance, Mahlangu has been told to stop taking her other ARVs until lamivudine becomes available.

Still breastfeeding her son, Mahlangu fears she may be putting her son at risk of contracting HIV through her breast milk if she remains without medication.

“I don’t know if he will be infected or not because at the clinic they did not say anything to me,” she told Health-e News. “They just said I must keep on coming to check if the medication is available.”

Lamivudine shortages have also been reported at Boksburg’s Tambo Memorial Hospital and the Treatment Action Campaign’s Jabu Mahlangu has alleged the drug has been out of stock since late November.

No ‘one-size-fits-all’ solution for patients

Fellow Daveyton resident Annah Manana was given an alternative combination ARV at her local clinic in lieu of her usual single tablet of lamivudine. While Manana has responded well to the switch, HIV Clinicians Society of Southern Africa CEO Lauren Jankelowitz cautions there is no “one-size fits all” solution for patients who are not able to get lamivudine.

[quote float= right]”I don’t know if he will be infected or not because at the clinic they did not say anything to me”

According to Jankelowitz, many patients who take lamivudine as a single tablet as part of an ARV cocktail may have already tried standard or “first-line” treatment combinations without success. This means that it many cases, doctors will need to tailor solutions for these patients that take into account not only other current medication they are taking but other ARVs they have tried in the past.

“Often patients have already ‘defaulted’ and are on second line with lamivudine,” she told Health-e News. “There is no standard advice for that reason.”

She added that a lamivudine shortage would be worrying because many patients on the drug may not have many other treatment options.

Gauteng Department of Health Spokesperson Steve Mabona has confirmed a shortage of 300mg tablets of the drug but says smaller dose formulations of the drug are available.

“We wish to confirm that, there is a shortage of lamivudine 300mg, however, we do have lamivudine 150mg tablets in stock,” said Mabona, who urged health professionals to consider dispensing a double dose of the smaller, 150mg-formulation in lieu of the usual 300mg tablets.

Mabona said the shortage of higher dose tablets is being addressed. He blamed the fact that some patients were being turned away empty handed from clinics on a miscommunication between district pharmacies and clinics.

According to Jankelowitz, patients with questions or concerns about missed doses can phone on 011 728 7365 or email sahivsoc@sahivsoc.org. Patients can also sms reports of stock outs to 084 855 7867 or via the civil society coalition Stop Stock Outs website. – Health-e News.

An edited version of this story was also published in The Star newspaper

• What’s behind a stock out? Read why many stock outs remain hard mysteries to crack
• Read more from Health-e News intern Thabo Molelekwa 

[Updated 8 January 9:46am: Following this story, the National Department of Health has released a circular advising healthcare worker and clinicians that 300mg tablets of lamivudine will no longer be available on tender as adult patients who usually take the 300 mg tablet are eligible for one of three other combination ARVs on tender. The Department of Health has urged clinicians to make use of these combination ARVs and to reserve use of the 150mg lamivudine tablets of children and complicated cases]