Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.
Mail & Guardian (Johannesburg) - March 20, 1998
Lynda Gledhill
Drug therapies have proven to be very effective at fighting the virus and have dramatically improved the outlook for many patients.
"[Many] people still have the perception from the early days of the disease that a person with Aids is doomed," said Dr Steve Miller, a Johannesburg general practitioner. "[However], those who have been following its treatment look at it as a chronic, ma nageable condition."
Miller acknowledges that the outlook for a South African with HIV today is "relatively poor". This is because the drug combinations used in the United States and Europe can cost between R900 and R4 000 per month.
However, Miller said too many people get hung up on the "triple cocktail" method. "It is a fallacy ... that everyone needs three drugs," he said. "People need as much as is necessary to control the virus."
A combination of protease inhibitors and antiretroviral agents such as AZT is often used. A minimum of two drugs is preferred because the virus can build up rapid immunity, said Professor Gary Maartens of the University of Cape Town's medical college.
"One drug would perhaps gain a patient six months to a year of reduction in serious infection," he said. "Two drugs are twice as good, and three drugs are at least twice as good as two drugs."
Currently, none of these drugs are available to state patients. "We try to get people on to drug trials," said Dr Saul Johnson, an Aids research co-ordinator at the Chris Hani Baragwanath hospital. "Other than that, we give supportive care." This include s treatment with antibiotics, immune boosters and vitamins.
"We treat common conditions not particular to people with HIV, but that people with HIV get," said Dr Clive Evian. These include pneumonia, herpes and tuberculosis.
However, Miller said the idea that the government does not provide drug therapies because of cost is a "silly premise. They spend much more treating illnesses that could have been prevented. It's a matter of re-allocating resources."
Miller said an effective drug combination costs between R900 and R1 500 per month. "This is very comparable to other major illnesses," he said. However, most insurance companies do not cover the cost of HIV-related drugs.
Others believe the problems facing the state in trying to supply drug treatments are too numerous. These include counselling, sufficient running water and getting people to follow a strict drug regimen. Said Evian: "People start to feel better and stop t aking their pills."
Some doctors encourage other treatments. "We can do a lot to improve quality of life without using expensive antiretrovirals and without using experimental treatments," said Maartens.
Immune boosters have received mixed support. One such treatment, Moducare, developed at the University of Stellenbosch, is being used with a great deal of success at a clinic in Botswana, according to the clinic's head, Dr Keith Scott.
A black market has developed around the drugs. This is worrying, said Johnson.
"They make capsules to look the same [as AZT] and then fill them with talcum powder. You never know what you are getting."
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