New Vision (Kampala) - December 5, 2006

I have been on ARVs for the last three years and my health has improved since I started ART. However, recently when I went to collect my monthly supply of drugs, I was given generic ARVs made from India instead of the brand drugs made by GlaxoSmithKline (GSK). Someone told me that drugs from India could be fake. Am I safe with generic drugs? Please help.

Ruth

Dear Ruth,

It is nice to hear that your health has improved on ART. Please keep swallowing them and following the instructions. Now, concerning the difference between brand drugs and generics, I wish to advise that so long as they are genuine, they work in the same way. You should not worry.

When a company like GSK discovers a drug, it has property rights protecting its interests until the money it has invested in the venture is recovered. After this, these rights can be lifted so that others can make copies of their discovery, which are usually cheaper but not necessarily inferior.

Look at it this way: Suppose you were to make a cake by putting together ingredients such as wheat flour, eggs, blue band, etc, you could call it The Ruth Cake.

That would be the brand name of your cake under which you market it and people who want to buy it would have to call it that name to differentiate it from other cakes. You could keep the recipe a secret so that others do not copy it.

However you could share your recipe with others who could mix the ingredients in the same proportions and make cakes, which taste exactly like yours.

These cakes, though the same as yours, cannot be called Ruth Cakes because you did not make them. That is the way I understand the relationship between branded and generic drugs.

We, in resource-limited countries should actually push for more generic drugs on the market because they are cheaper and will help us put more people on ARVs.

In Uganda for example, of the 200,000 estimated to need ARVs, only about a third can access them! The main constraint is lack of money. Use of generic drugs would reduce this problem.

Lastly The National Drug Authority can verify whether drugs are fake or genuine.

Remember both branded and generic drugs can be faked, so always get your drugs from centres accredited by the Ministry of Health, which are supervised and have proper storage facilities and qualified staff.

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Can ARVs cause mental illness?

Dear Doctor,

My HIV-positive mother was started on ARVs about six months ago. She has since generally been fine and her CD4 count even went up. However, for about a month now, she has been behaving in a strange way and has even attempted to commit suicide because she says she hears voices, which torment her! Can ARVs cause someone to run mad?

Sophie

Dear Sophie,

Thank you for this important question and sorry that your mother is not enjoying good health while on ART.

Mental disorders which occur in people who are HIV negative, can occur in those who are positive and in fact there is a higher incident of these disorders because of the great stress that people who have HIV undergo.

It is therefore important that People Living With HIV/AIDS (PLWAs) have on-going counselling to help them cope. HIV psychosis is also well documented since the HIV affects all body cells including the brain cells.

Sometimes the normal counselling given by HIV/AIDS counsellors may not be adequate and some patients may need the help of a clinical psychologist. Your healthcare giver should be in position to advise you on how, and possibly, where to get this specialised care.

However, if the problem is grave like you describe, take her to see a psychiatrist who has specialised training in managing mental disorders or diseases.

Your mother should, however, continue taking her ARVs under supervision while you seek further help.

In order to deliver holistic care for PLWAs, we need teamwork involving different specialities.

It is unlikely, though, that this condition has been caused by ARVs since it started months after they were initiated.

The only drug that could cause what your mother is having is Efavirenz, which we commonly use. It can also cause lack of sleep or insomnia, impaired oncentration, abnormal dreams or hallucinations like However, these occur early and not after one has been on the medication for several months.

Lastly, mental diseases like HIV/AIDS carry stigma and people often deny having the problem, ignoring it until it is too late to be helped.

It is important that all people who exhibit abnormal behaviour seek medical care early from qualified and competent healthcare givers.

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Send your question on HIV to Health Editor, The New Vision. P. O. Box 9815, Kampala or health&beauty@newvision.co.ug

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