About 4 million HIV-positive South Africans who rely on the states single dose antiretroviral treatment (ART) are at risk of grave liver damage and death due to elements contained in one of the drugs.
The anti-HIV Efavirenz contains elements which have proven devastating to the liver even in patients who were healthy at the time of ART initiation and with no prior Aids-defining illness, a study has found.
The risk is uncommon; the disease is rare, but it is very important that caregivers of HIV-positive people know this so they can identify liver disease and quickly change the treatment, said University of Cape Town specialist Professor Mark Sonderup.
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He and six other health experts released the results of research into the effects of the Efavirenz -based treatment this week.
It may be uncommon at this stage, but because we are treating more than 3 million people, we have to know the risks involved,he said.
Sonderup said the percentage might be small, but a small percentage of a lot of people is significant.
The standard of care for South Africans with HIV includes the once a day pill containing three drugs.
The programme was introduced by Health Minister Dr Aaron Motsoaledi in 2013.
The tablet contains tenofovir, emtricitabine and eFavirenz and its introduction reduced the treatment regimen of many tablets taken several times a day.
Efavirenz is an HIV inhibitor and responsible for blocking the growth of HIV in an infected persons body. It should not be used by people suffering from liver problems or those who have high cholesterol, according to the Medical Journal.
It was given high praise at the time of its launch, partly because it was less cumbersome to the patients and would enable more people to be put on treatment.
Do not use it on patients with a history of abnormal liver function tests or liver problems like hepatitis, the Medical Journal instructed care-givers.
It also described the drug as one that slowed down damage to the immune system and prevented the occurrence of Aids-defining illnesses.
It belongs to a class of drugs which stop HIV from replicating within cells by binding near reverse transcriptases active site and inhibiting polymerase activity, it stated.
But Doctors Without Borders head of department for the Southern Africa Medical Unit, Dr Tom Ellman, said Efavirenz based treatment was generally less toxic than some of the others used to treat patients with HIV.
All ARVs are strong drugs, and all have side effects
He said there was no need to cause a scare and sensationalise the findings.
We are treating a deadly disease and our priority as workers in the Aids field has been to get people on to ARVs,†he said.
Ellman also said it was important for doctors and nurses to know liver problems so they identified them quickly to avoid the complications uncovered by the study.
We believe it is the right drug for our people, he said. There was research being done on reducing the dosage of the drug, Ellman said.
The research by Sonderup and his colleagues was ongoing, the preliminary results released to ensure the right information was out there in the public domain.
The rollout of ART in South Africa has gained momentum over the years and no less that 1 000 people are initiated on to treatment every month,â Sonderup said.
We are not saying people must stop, they must just be aware. We need people to know because this is the programme we are using in South Africa.
When it was first produced in the United States in 2008, Efavirenz was not the preferred first-line option of treatment.
It also carries many other side effects, some neurological and psychiatric, with patients claiming to be brain damaged from using it.
Users have also complained of insomnia, confusion, memory loss and depression.
Psychosis and aggression have been identified in other patients, said the Medical Journal online.
This drug helps keep us alive, but it can make that life so poor in quality it doesn’t seem worth being alive,a patient said.
If information was not disseminated quickly, South Africa ran the risk of killing a population in need of treatment, which would be no different from genocide, said Aids activist Pehello Mbonambi.