Important note: Information in this article was accurate in 2001. The state of the art may have changed since the publication date.
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New Vision (Kampala) - December 24, 2001
Charles Wendo
The Washington Post, a prestigious newspaper in the United States, reported on December 19, that half the Americans living with HIV had strains that were resistant to at least one drug.
Ugandan experts on Thursday told The New Vision that the situation is not as bad here, but it is certainly going to get worse.
The anti-retroviral drugs that have since 1996 been used to prolong the lives of AIDS patients, normally suppress HIV to the extent that the virus can not be detected in blood. Patients who had been on their death beds have returned to work as a result of the treatment, a situation that doctors now refer to as the "Lazarus effect."
But the Washington Post, citing a paper presented during a scientific conference in Chicago, reported that the virus has now developed resistance in 49% of the people taking the drugs in the US.
The findings suggest that an unusually large number of people face the risk that their HIV infections may become difficult to treat. Moreover, the resistant virus can spread from one person to another through sexual intercourse or blood contact.
American physician Douglas D. Richman said: "It's a wake-up call that we've created a lot of resistance with the use of our drugs, and that it's happened in a short period of time."
Dr. Peter Mugyenyi, Director of the Joint Clinical Research Centre, said they have detected patients in Uganda who carry the resistant strains of HIV. He, however, said it is not as bad as in the US. This is because the drugs are not used in Uganda as widely as in the US.
"The Americans have used these drugs longer and on a larger number of people. So when we compare ourselves with them we have got less resistance," said Mugyenyi.
Mugyenyi, one of the first doctors in Uganda to begin treating patients with anti-retroviral drugs, warns that it's going to get worse as the number of people on the drugs increases. "The resistance will come. That is why people must use the drugs very carefully," he said. He said in Uganda the cost of HIV treatment increases at least five times when someone gets the resistant strain of HIV. Currently the cheapest three-drug combination recommended for most beginners costs sh72,000 per patient per month. But if the virus becomes resistant to any of the three, doctors have to introduce a new drug. This hikes the cost from sh72,000 to more than sh300,000. If doctors substitute two drugs then the price could be much higher. "You may use four or more drugs to get somebody out of resistance, then the old prices come back," he said.
Patients who cannot afford the new prices caused by drug resistance might drop out of the treatment and possibly die. Besides, the new combination to overcome resistance is a bit more complicated. Instead of taking the drugs once or twice a day, the patient has to take it several times a day.
But where does the virus get resistance? Doctors say it is the consequence of taking medicine for too long without clearing the virus. Patients take the anti-retroviral drugs daily, indefinitely. With experience, the virus develops means to evade the drugs. It's like rats that learn to evade a trap after it has killed a number of their friends.
"When you use anti-retroviral drugs resistance is inevitable. But you can minimise the chances and delay it as much as possible," said Mugyenyi.
He said that people taking anti-retrovirals should strictly follow medical advice to minimise the chance of their infection becoming resistant to drugs. He also said people should get treatment only from qualified doctors who have been trained on how to handle the drugs.
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