Andrew
Phillipa Mukome-Chinhoi
During the last two years, all other health needs were largely parked, with all eyes on the devastating Covid-19 pandemic.
In most countries, some hospital units were closed, with essential services like maternity, emergency unit and Covid-19 red zones being the few that were fully operational.
The Covid1-19 pandemic brought a new dimension to the HIV and Aids response.
World Health Organisation (WHO)’s latest data shows that 1,5 million people were infected with HIV in 2021, and that another 1.5 million were infected in 2020. Could these figures be related to the global Covid-19 pandemic, which significantly upset general health delivery across the globe?
Research should look into the possible correlations of the recent high HIV infections, and the Covid-19 pandemic and its impact on ongoing HIV cure research and roll out of available prevention methods.
In a statement, director of WHO’s Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Dr Meg Doherty, said HIV prevention efforts have stalled, with 1,5 million new HIV infections in 2021 – the same as 2020.
“There were 4 000 new infections every day in 2021, with key populations (sex workers, men who have sex with men, people who inject drugs, people in prisons and transgender people) and their sexual partners accounting for 70 percent of HIV infections globally.
“Long-acting cabotegravir is a safe and highly effective HIV prevention tool, but isn’t yet available outside study settings.
“We hope these new guidelines will help accelerate country efforts to start to plan and deliver CAB-LA alongside other HIV prevention options, including oral PrEP and the dapivirine vaginal ring,” added Dr Meg Doherty.
This is cause for concern. An HIV cure is necessary to manage the burden.
Southern Africa carries the brunt of the HIV infections, and Zimbabwe is not spared. With science working around the clock to find a cure, 15 percent of patients on ART programmes in Africa are on second-line, ritonavir-boosted protease inhibitor PI regimens. But this proportion will increase significantly over time.
A recent UNAIDS 2020 report has shown that most patients failing second-line ART in resource-limited settings do not have major PI resistance-associated mutations. This means that failure is due to poor adherence, rather than the development of resistance. With more patients failing on second-line ART regimens for longer durations, this will likely change. The threat of “untreatable” multi-drug resistant HIV after second-line failure in Africa is a cause for concern.
According to the Ministry of Health and Child Care, as of June 2022, Zimbabwe had 49 944 people on second line regimen with 489 on the third-line. The third-line being the last treatment, anyone failing that books a berth in the cemetery.
Mrs Tariro Kutadza, the women representative of communities affected by HIV, TB and Malaria in Global Fund CCM, said it is critical to adhere and remain on the first-line regimen.
“We encourage PLHIV+ on ART to adhere and remain on first-line for cost and tolerant less pill burden. The higher the line, the heavier it is to the immune compromised body,” she said.
She added: “We address this by investing in prevention and awareness raising on Treatment Literacy.”
Ms Kutadza added that a cure was needed soon.
“With 1,2 million people living with HIV in Zimbabwe, if funds and facilities permitted, finding willing participants to a cure would not be a challenge.
“However, scientists are at work and we keep hope alive for the HIV Cure. “With Global Fund CCM calling for ending AIDS by 2030, the 2022 to 2025 global funding requires US$18 billion,” she added.
According to Ms Kutadza, ending AIDS by 2030 implies that HIV treatment will be generalised.
“Anyone infected will be treated like any patient seeking services for a headache or diarrhoea,” said Mrs Kutadza.
Hope is there because research and development (R&D) is on-going. Uganda is currently developing genetic engineering policy, and the regulatory approval pathway. One Ugandan scientist is currently being trained to manufacture gene therapy products at the Fred Hutchinson Centre.
In an interview, Rufaro Murara (not real surname), who at one point wanted to give up on taking ARVs, said she was not happy with the pace that researchers were taking in finding the cure.
“Yes, there are now many prevention pills and ways, but it looks like they are concentrating more on these.
“Why not put more effort on the cure? There are those I know who have reached the third-line regimen, what are they going to do? It is so frustrating and scary, I hope they find the cure soon,” said Murara.
She said most vaccines after being approved take too long to be delivered to the Third World.
These she added include the new CAB-LA alongside other HIV prevention options, including oral PrEP and the dapivirine vaginal ring.
Professor Sharon Lewin, the new president of the International AIDS Society, said: “While strengthening HIV cure research in Africa is a top priority, because of the high burden and distinct characteristics of HIV in the region, a cure which is scalable, affordable and available will only be achieved if researchers engage and work with affected communities, local scientists, and local HIV care advocates.” ENDS
Online Reporter