New HIV drug safer‚ more effective and cheaper

The new antiretrovirals South Africa will introduce in 2018 are cheaper‚ have far less side effects than current drugs and HIV cannot develop resistance to them.

"It's not often in medicine we get something safer and more effective that is also cheaper. This is a big step forward‚” said Deputy Director of the Wits Reproductive Health and HIV Institute Professor Francois Venter.

In medicine‚ usually better drugs are more expensive‚ he explained.

Last week‚ Bill Gates announced at UN General Assembly the drug would be scaled up by manufacturers at a capped price of $75 dollars a year. The Gates Foundation has given a financial assurance to drug manufacturers that the volumes needed for a low price would be bought.

South Africa offers three drugs in a single pill and one of the drugs - Efavirenz - will be replaced with the new drug‚ Dolutegravir‚ which has far fewer side effects.

Dolutegravir is used by HIV positive patients in Europe and America.

Efavirenz‚ which is used locally‚ causes depression in some users as well as insomnia‚ nightmares and hallucinations. It can cause severe liver damage in very rare cases. Dolutegravir is more pleasant to take‚ which the health department says could mean people adhere to treatment better. If a person takes ARVs properly‚ the medicine stops the virus replicating and they become non-infectious.

Health department spokesman Joe Maila said: “Dolutegravir is …. well tolerated by patients and has fewer side effects. Patients are therefore more likely to be adherent and more likely to be virally suppressed – which means that they are not likely to transmit the virus to others."

South Africa has the largest HIV treatment programme in the world with the lowest-priced ARVs. There was no way to manufacturer the current treatment any cheaper‚ which is sold at less than R90-a-month per patient.

The new drug Dolutegravir is cheaper because less ingredient is needed in the pill. "It is cheaper to make‚" said Venter.

A cheaper price will be one way to scale up treatment available‚ from 3.9 million South Africans to about 6.5 million people who are HIV positive. It is government's policy that all positive people get treatment.

Dolutegravir is a drug that the virus does not become resistant to.

This means less people will require more expensive ARV drugs due to resistance. It is completely speculative‚ said Venter but scientists take a wild guess that 2% of people each year develop resistance to ARVs. Venter explained: "Dolutegravir has one of the highest resistance barriers we have ever seen – in over 600‚000 people treated‚ we have only seen one patient get resistance (and that was easily treated by adding another‚ very safe drug)".

It was announced that it will be provided from 2018‚ at only R75 dollars a person a year about R1‚000 a person.

In rare cases Efavirenz has caused fatal liver damage in a handful of patients on ARVs across South Africa. Hepatologist and UCT professor Mark Sonderup said he was pleased it was being phased out.

"From our perspective the move to Dolutegravir is immensely positive and will negate the adverse effects of Efavirenz such as the neurotoxicity and the infrequent but potentially fatal drug-induced liver injury we have described and continues to be seen across our country and other parts of sub Saharan Africa."

It is not clear if the new drug is safe for pregnancy yet or in patients on TB treatment.