December 1, 2021

Tackling Myths on HIV Treatment; Is There Special ARV Pills for Rich People?

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Antiretroviral therapy for HIV infection has changed dramatically in the past two decades. (Graphic by NIAID)

Years ago, people with HIV did need to take a lot of pills. Now, most people starting on HIV treatment take one to four pills daily. You may be able to take medicines that combine two or three drugs in a single pill.

The amount of pills that people living with HIV/Aids must take, has stuck around, largely driven by how long a cure for the disease has taken. When people are discussing the virus, the common assertion I’ll; you’ll have to take dozens of pills every day.

As of September 2019, Approximately 210,200 adults between the ages of 15-64 years in Rwanda were living with HIV (prevalence 3.0%), according to the Rwanda Population-based HIV Impact Assessment (RPHIA) released at the time.

The prevalence was higher in women (3.7%) than men (2.2%) and 1.9 times higher in urban areas compared with rural areas.

The incidence of HIV was 0.08%, translating to about 5,400 new cases per year in Rwanda. Among all adults living with HIV, 76% had suppressed viral loads. Women had higher rates of viral suppression (79.1%) than men (70.5%).

The survey found that of the adults who knew their HIV status, 97.5% were on antiretrovirals or ARVs. It is the medication which those living with the virus use to prolong their lives.

The health ministry says everyone in Rwanda who needs ARVs, no matter the type of drugs needed depending on their viral status, is getting them free of charge, even when these medicines are highly expensive.

But then, is everyone accessing the same medicines, or there are some taken by rich people? One of the supposed myths out here is that there are medicines taken by rich people, whereby they swallow a single pill for months.

As Rwanda joins the world to mark World Aids Day, December 1, we put the myth about ARVs for rich verses poor, to Dr. Simeon Tuyishime, the Director of HIV Care and Treatment Unit Director at the Rwanda Biomedical Centre (RBC).

“This is a nationwide service; there is no Rwandan who buys their own HIV medication. The government buys for everyone who needs it,” said Dr Tuyishime.

“The different treatments we have in Rwanda are World Health Organization approved standards. It is the same medication being given elsewhere.”

Dr Tuyishime said government is the sole importer of all medicines for all illnesses. “Private providers or anyone who needs any type of medication, gets it through the Ministry of Health.”

We put this to Dr Tuyishime in attempt to address issue as to whether there could be Rwandans importing their own HIV treatment.

Available ARVs in Rwanda

According to the UNAIDS, despite dozens of antiretroviral therapies developed, “Different classes of antiretroviral medicines work against HIV in different ways and when combined are much more effective at controlling the virus and less likely to promote drug-resistance than when given singly.”

Here, combination is made with at least three different antiretroviral medicines which most scientists consider as a ‘standard treatment’ for all people newly diagnosed with HIV.

In Rwanda, The Chronicles was exclusively provided with list of ARV medications available.

The ARVs available in Rwanda are classified in four types, as:

  1. Nucleoside reverse transcriptase inhibitors (NRTI): Tenofovir (TDF), Abacavir (ABC), Lamivudine (3TC), Zidovudine,…
  2. Non-nucleoside reverse transcriptase inhibitors (NNRTIs): Efavirenz (EFV), Nevirapine (NVP).
  3. Protease inhibitors (PI): Atazanavir(ATV), Darunavir(DRV), Lopinavir/ritonavir(LPV/RTV)
  4. Integrate inhibitors (II): Raltegravir, Dolutegravir

The combination, as to which type and how many tablets a person takes, depends on their viral status and age.

Dr Tuyishime explained: “For example, a person recommended to take Tenofovir(TDF)-Lamivudine(3TC)-Dolutegravir(DTG), is given a single tablet that combines all these named. The person takes that single pill daily at a specific designated time.”

However, there are some patients, considering their situation, who could be put on a regiment where they take 2 tablets daily at a specific time.

To illustrate further, we identified case of a young person or child. Depending on a host of other factors mainly their weight, that child will be required to take 1 tablet or two.

“There is no uniform prescription for everyone. Each person requires individualised treatment plan which has to be monitored constantly, as it could reach a stage where it has to be changed,” said Dr Tuyishime.

Antiretroviral drugs to treat HIV infection spill out of a pill bottle. (Photo by NIAID)

Does the state cover all treatment costs? YES!

Dr Tuyishime explains: “It doesn’t mean that even though people get this medications free of charge, then they are cheap. Government spends lot of money on these medications. I think people can vividly remember the period, not long ago, when HIV treatment was not available for everyone.”

In recent months, there have been developments about new research on the therapies due on the market.

In the UK, the government is scheduled to approve an injection.

Cabotegravir (also called Vocabria and made by ViiV Healthcare) and rilpivirine (also called Rekambys and made by Janssen) are given as two separate injections every two months, after an initial phasing-in period, reported the BBC.

However, the treatment is only suitable for those who have already achieved undetectable levels of virus in blood while taking tablets.

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