Health Minister Dr Zweli Mkhize has launched a new fixed-dose combination antiretroviral (ARV) treatment called tenofovir/lamivudine/dolutegravir, simply known as TLD.

“This is a new regimen that is going to reduce chances of people getting resistance and depression,”  Aurum institute’s Dr Regina Osih from tells Health-e. This is an improvement in the options available for people on ARV treatment, she says, people can stay on it for a long time with this regimen. 

However, according to Osih, not everyone is going to be moved to the new treatment immediately — people who are starting on HIV treatment for the first time will be put on the three-in-one pill first. 

Greenlight for DTG

Dolutegravir, also referred to as DTG, was approved as a first-line and second-line treatment for women of childbearing age by the World Health Organization (WHO). 

This is after initial data from Botswana’s Tsepamo study linked the drug with neural tube defects (NTDs) in infants born to women using dolutegravir at the time of conception. But new data, again from the Tsepamo study, and from Brazil, now shows that the risk for birth defects is much lower than intentionally signalled. 

Studies show that DTG is far more tolerable than the older more common drug efavirenz, which patients have reported causes depression and hallucinations in the first few months. These side effects could lead to people not staying on treatment. 

“DTG is a drug that is more effective, easier to take and has fewer side effects than alternative drugs that are currently used. DTG also has a high genetic barrier to developing drug resistance, which is important given the rising trend of resistance to efavirenz and nevirapine-based regimens,” states the WHO.

According to the National Department of Health, the bulk of the HIV treatment programme is funded through a conditional grant by the national fiscus. 

Osih says the new treatment is expected to be available in from December after Mkhize’s launch.

‘Pill burden is almost non-existence’

Yvette Raphael, programme manager at Advocacy for Prevention of HIV and AIDS,  says this treatment is a step in the right direction because the new combination has little side effects and resistance is most minimal.  “This is a small pill, so it will take people from the pill burden because they will be able to take it very easily. I am excited about this, because people will live longer and that the pill burden is almost non-existence,” she explains.

But, she says, the government must also focus on counselling and encouraging adherence because people take treatment for many different reasons. 

“Although there are issues around weight gain, we’re actually better off than [with previous ARV drugs] where people had to choose whether they are going to stay alive or going have deformed bodies. We’re excited but we also to have to bring in social and behavioural communications because people need to understand the importance of being active, eating healthy and taking less sugary drinks,” Raphael adds. 

Over the past few months, South African public health facilities have been facing HIV drug stockouts in, but Raphael says that the South African government has no excuse for stockouts because of the new HIV drug is affordable. 

“This generic is much cheaper, they have no excuse not to scale-up viral load testing.” – Health-e News

[Updated 8:47 pm 29 November 2019. Health-e corrected the story to reflect that treatment rollout starts in December, not January. The rollout will not be in phases, as previously stated.]