“There is a real risk of patients developing a resistance to antiretrovirals (ARVs) if they are removed from recommended treatment regiment over time.”
This disclosure was made by Programme Manager of the National AIDS Programme Secretariat (NAPS), Dr Shanti Singh, when she commented on the recent shortage of ARVs which had rocked the local health sector. However, she asserted that the possibility of persons developing resistance to ARVs is not likely.
This newspaper had reported that there was a countrywide shortage of the ARV Efavirenz, one of the medications offered to persons living with the Human Immunodeficiency Virus (HIV). The health sector had a sufficient supply of another drug Truvada, but did not receive Efavirenz, which is recommended to treat some patients whose condition requires that they be treated with a cocktail comprising the two pills.
Tenofovir/emtricitabine trademark Truvada, is a fixed dose combination of two antiretroviral drugs used for the treatment of HIV. It consists of 300 milligrams of tenofovir and 200 milligrams of emtricitabine. By combining the two agents into one tablet, it reduces the pill burden and increases compliance with antiretroviral therapy. Efavirenz combined with Truvada, consists of tenofovir and emtricitabine, all of which are reverse transcriptase inhibitors. This combination of three medications was approved by the U.S. Food and Drug Administration (FDA) in July 2006 under the brand name Atripla and provides Highly Active Antiretroviral Therapy (HAART) in a single potion taken once a day. It results in a simplified drug regimen for many patients.
According to Dr Singh, “as clinicians and as persons who manage people living with HIV, we always say that antiretroviral therapy is not an emergency, however when persons are placed on antiretroviral therapy it is important that they continue their treatment, and we always emphasise things such as adherence and compliance.”
However in the case of the recent hiccup which had developed in the supply chain management system, Dr Singh asserted that there is currently no reason for panic.
“We had the feeling that persons were panicking, and I think it was a natural reaction if you are a person living with HIV/AIDS and are on ARVs, you know the importance, because we have been counselling patients over and over on the importance of having their medication and not interrupting treatment and so forth, and suddenly you are told you can only get a week’s supply…naturally people would panic.”
The Programme Manager admitted that the situation had somewhat of a ripple effect after persons seeking care at treatment centres were able to figure out that something was amiss.
In wake of the development, Dr Singh said NAPS, as the technical office of the AIDS programme, had met on a regular basis to monitor the situation and was able to engage intervening measures.
“We were able to firstly switch the regiment that the patients were on to an alternative regiment.” This information, she said, was sent out to the treating physicians, the Regional Health Officers and to all persons involved to be alert of the situation and to ensure that patients’ treatment would not have been interrupted given the unavailability of Efavirenz. The Secretariat, Dr Singh revealed, had taken on the task to deliver the alternative regiment to the various treatment sites.
“We worked until late into the night…we had clinic staff at all of the treatment sites waiting to make sure that they picked up the medications.” The alternative regiment which was offered was for the maximum of two weeks in anticipation of the arrival of the Efavirenz drug. However, it was two days after the evident shortage that the depleted Efavirenz had arrived in the country, Dr Singh added.
A special effort was again made by NAPS to make sure that the much needed medication was distributed back into the system. “If patients were on that alternative regiment it was probably for about two to three days maximum after which they were switched back to their Efavirenz based regiment,” Dr Singh noted.
And there are several categories of persons that are enlisted in the treatment programme, according to the NAPS official. The majority of patients, she said, are currently on first-line medication while there is a small percentage on second-line medication and then there are the paediatric patients. She explained that there are some persons who are being taken care of, but are not necessarily on ARVs.
“The recent hiccup that we had affected the Efavirenz-based persons who are on first-line treatment and not all of our population; it was only a proportion of our patients that were affected, the rest of persons continued on their normal regiment.”
Those patients that were affected were merely without the needed medication for a maximum of three days, Dr Singh revealed. And during the period that patients were exposed to alternative treatment there were thorough consultations on what that meant for the treatment programme.
And Dr Singh has every confidence that the recent hiccup will have no negative impact.
“The regiment that we had prescribed is a triple-nook regiment as they are all from the same class. The Efavirenz-based regiment is actually a combination of two classes of drug…”
And since there is a standard regiment of drug used across the world, Dr Singh disclosed that Guyana’s intervening move should not be a troubling one. She added that no effort will be spared to pay close attention to patients to determine if there is in fact any noteworthy development due to the recent shortage.
Minister of Health, Dr Leslie Ramsammy, had asserted that the shortage had resulted through no fault of Ministry of Health officials. The Ministry has never faced such a problem before, and usually receives its antiretroviral stock from Europe in a timely manner as per order. However, the situation, he had revealed had stemmed from a shipment problem which resulted in only one type of HIV drug arriving as at the last arrival date, several weeks ago.
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