Third-Line ARV drugs... where art thou?

Last year, Government through the Ministry of Health said it would introduce third-line antiretroviral therapy (ART) as response to treatment failures of the first and second lineregimens. HIV/AIDS activists in Zimbabwe overwhelmingly welcomed the move since the third-line ARV drugs would address the problem of drug resistance. But sadly, twelve-months down the line, the introduction of such a brilliant initiative, that gave a ray of hope to drug resistant patients, could have just melted away. 

According to a research by PharmAccess, a Dutch foundation providing HIV treatment services to the private sector in sub-Saharan Africa, has shown that in 11 countries, transmitted drug resistance increased by 38 percent for each year the country scaled-up ARV treatment. But third-line drugs are either unaffordable or unavailable in many developing countries.

THE World Health Organisation (WHO) announced a summary of new recommendations as far as consolidating ARV guidelines. According to the recommendations, all populations globally should come up with national programmes through policy for third-line ART. I feel that if the Ministry of Health, advocated for a national policy on third-line ART, last year just after saying that it wanted to introduce third-line drugs, maybe today Zimbabwe would be singing a whole new different song. 

File graphs of possible projections of thrid-line ARVs.

The change of patient’s regimen due to the emergence of resistance means relying on newer, patented, and thus expensive drugs. The price of a third-line regimen is nearly 15 times more than the most affordable first-line regimen, and over six times more than the most affordable second-line regimen. Third-line ART are prohibitively expensive and without adequent funding, governments cannot effectively introduce them. Patients and treatment providers are once again faced with the prospect of drugs being priced out of reach.

HIV drug resistance can be acquired, in which resistance develops following a patient's poor adherence to treatment, or transmitted, in which a person becomes infected with a drug-resistant strain of the virus. 

Levels of drugs resistance in sub-Saharan Africa are less than five percent, but a few studies in East and Southern Africa have reported increasing levels of transmitted drug resistance. 

Zimbabwe, which introduced ARV therapy in 2004, is reaching an estimated 650 000 with treatment, with an estimated 15 percent in need of the drugs. At the moment, patients that have failed to respond to second-line ART are being referred to research organisations.

To wrap it up, the long awaited introduction of third-line ART, could help solve the increasing number of patients resistant to ARVs.

Let's keep the promise!