Recent ARV shortage was a learning experience – Dr. Singh
It is highly unlikely that a patient on antiretrovirals (ARVs) could develop a resistance if he or she is unable to take the recommended medication over a 24-hour period. In fact there may be no side effects over a two-week long period. This assertion has been made by National Aids Programme Coordinator, Dr Shanti Singh, who revealed that “I think that 12 or 24 hours is too short…”
She disclosed that in very mature treatment programmes, one of the strategies that is employed is a feature called structured interruption of treatment. According to her, doctors have been known to introduce a strategy whereby patients who have been on antiretrovirals for a number of years are given a drug holiday, because the body has to do extra work to be able to process the ARV medication. This process, she said, could be as long as two weeks, and still it has been proven that the Human Immunodeficiency Virus (HIV) in patients will not become resistant to the recommended treatment when reintroduced.
Guyana’s stock of Efavirenz, one of the drugs used to treat HIV patients, had become depleted due to a shipment problem, according to Minister of Health Dr Leslie Ramsammy. That problem has since been rectified, and the local sector currently has a sufficient supply which will last until next year.
According to Dr Singh, the patients using Efavirenz in the local treatment programme are probably the most controlled as they are the patients with very low viral loads. The HIV viral load is an important measurement of the amount of active HIV in the blood of someone who is HIV positive, and also indicates if a patient’s medication regimen is working. With a low viral load, HIV positive patients are less likely to infect others. However, Dr Singh said that transmission is not impossible, although the risk may be deemed minimal.
A deliberate drug holiday, Dr Singh said, is a proven strategy that can help patients to “really take a little break and come back re-energised” to be able to adhere better to treatment.
“So, a slight interruption, if there were any interruptions, for any patients would not necessarily result in HIV drug resistance.”
The recent drug shortage was in fact a learning experience to the Secretariat as according to the Programme Coordinator, it was discovered that in order to make informed decisions, all of the necessary information must be available.
“I think we had somewhat of a challenge when there were bits and pieces here and there, but we did not have all of the information. The other thing that I have learned from the colleagues that I have consulted with is that experience really counts.”
According to Dr Singh, she had to consult with not only colleagues who work in United States-based programmes, but also those who work in programmes all across the world, including countries such as Nigeria, Uganda and Botswana. She related that they were able to extrapolate from their experiences in similar settings to Guyana, and to offer advice.
“I think the real challenge for me was knowing that we really had limited options…The options are limited because of how tight our treatment guidelines are, and we have really made our treatment guidelines specific in the first place, so that we get good adherence and compliance to prescribing practices…”
Guyana’s decision to have a control mechanism in place was geared at restricting or decreasing HIV drug-resistance among patients, without anticipating that a drug shortage was imminent, Dr Singh disclosed.