Advancements in Anti-Retroviral Therapy: Towards Enhanced Treatment Safety

By Catherine Murombedzi

Harare:Since the initial identification of HIV as a global health crisis, more than 40 years ago, considerable progress has been made in the realm of antiretrovirals (ARVS). The primary goal of these therapeutic agents is to suppress viral replication. When virally suppressed, the immune system is restored. This improves the overall health of individuals living with HIV (PLHIV). When virally suppressed, the transmission of the HIV virus is curbed.

Dr. Tadesse Mekonen, Executive: Clinical Research and Development, Avacare Health Group, speaking at the international Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) shared science and research findings on enhanced safety of drugs for people living with HIV (PLHIV). The conference ran from 4 December to 9 and attracted around 4800 delegates from across the globe with 2400 attending virtually.

There is a wide variety of ARVs, safety is the most important element. The transition from Tenofovir Disoproxil Fumarate (TOF) to Tenofovir Alafonamide Fumarate (TAF) for enhanced safety was topical.

“Over 30 ARVs have been approved, each with varying efficacy and safety profiles.

“The widespread adoption of Tenufovir Disopraxi Fumarate (TDF) administered at a dosage of 300mg once a day in combination with Emtricitabine (FIC) and Dolutegravir (DTG) has been a comerstone in first-line HIV treatment. Despite TDF’s efficacy in viral suppression, its usage raises significant safety concems, notably nephrotoxicity and a reduction in bone mineral density.

“There adverse effects are particularity pertinent in populations with a predisposition to chronic diseases, such as those of African descent.

“However, the introduction of lecotovir Alafenamide Fumarate (TAF), a novel prodrug of lenotovir, marks. a significant advancement in the safety of ARV regimens. “Administered at a dosage of 25mg daily in conjunction with FTC and DTG, TAF demonstrates superior renal and bone safety profiles compared to TDF, Clinical trials across diverse setting have substantiated these findings, additionally suggesting the potential for reversing TDF related toxicities upon transitioning to TAF-based regimens,” he said.

“Despite these improvements, TAF is not without its drawback, induding associations with weight gain and elevated lipid levels. “Nevertheless, its introduction in several African countries, induding Botswana, Namibia, Zambia, and Zimbabwe, represents a significant step forward in advancing the management of HIV,” he added.

Safety concerns have been a major concern to PLHIV.

Gumisayi Bonzo, an activist and Executive Director of Trans Smart, a local organization championing the cause of the transgender minority community from Zimbabwe is concerned with the one size fits all.

“Locally, we have no treatment prescribed after tests are run to determine if the treatment is suitable.
If one is HIV+, one size fits all. My treatment regimen was lowered from Tenofovir 600mg to 400mg after I developed challenges. I was growing a hunch on the neck with serious weight gain. It’s unfortunate that our limited resources see us bunched without tests run. For a year, the nurse would tell me that the reactions are normal. I had to go to a bigger health facility where the doctor ran tests and sent the samples to the laboratory. It was found that 600mg was too much. I had taken that overdose for a decade. I imagine the damage to my organs, many people on ART finally have organ failure. ART is for life,

so prescription must be comprehensive and tailor made to suit the patient,” said Bonzo. In the early 2000s, stalanev was used in Zimbabwe. It had severe side effects, and was stopped. In Zimbabwe stalanev was last used a decade ago. However, the physical damage is permanent. Disfigured thin faces and legs. For people on ART, it is easy to notice the permanent damage that stalanev caused to those who used it.

People Living with HIV welcome the findings by Avahealth,

Speaking on the sidelines on ICASA, Otillia Tasikani, a widow from 1990 had this to say.

“I follow science, today, PLHIV have a new lease of life because of ARVs. Such advances on our safety are applauded. With Avahealth available locally, we welcome the safety concerns. As advocates, we add our voices to have these replacement drugs available locally. We have have cases of people who fall and break bones. Usually, anyone above 60 is told that it is old age. These findings shed light, treatment literacy is important to us as we manage our health” said Tasikani.

PLHIV have been pivotal in access to health and have been a cog in the success of the national response.

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