single pill arv treatment welcomed The South African National AIDS Council (SANAC) has welcomed the introduction of a simplified ARV treatment of just one pill a day for some public sector HIV positive patients.

This change in treatment protocols by the Department of Health came into effect at the start of this month.

Known as a fixed dose combination (FDC) anti-retroviral (ARV) treatment, the single tablet contains a combination of three vital ARVs; Tenofovir, Efavirenz and Emtricitabine. It is expected that the move will help encourage patients to stay on treatment, reducing incidences of non-compliance and non-adherence.

"Instead of taking several pills at different times of the day, the FDC allows for patients to take one pill once a day, which will improve adherence," commented Rev Bafana Khumalo, the national chairperson of the SANAC men’s sector.

Vuyiseka Dubula, an executive member of SANAC’s sector of people living with HIV (PLHIV), also welcomed the news, saying that: “Adherence is very critical to the success of treatment. There are many reasons why people do not adhere to their medication. Amongst them are issues of high dosages or too many pills to take (which is also known as pill burden) and side-effects.

"Too many people, about 70% in South Africa, have HIV and TB at the same time and in most cases they have to take treatment for both illnesses simultaneously. This means many of us take far too many pills and that discourages some not to take them.

"The introduction of fixed dose combination therapy is a very progressive step towards improving and reducing factors that contribute to poor adherence,” said Dubula.

“We have come a very long way since the advent of anti-retrovirals,” noted Dr Fareed Abdullah, SANAC CEO. “At one point, patients used to take up to 16 pills a day.”

According to Dr Abdullah, “not everybody will switch to one pill a day immediately, as the Department will roll this out over the coming months. Patients who are on second line treatment will not be switched to the one pill a day. Patients should talk to their doctors and nurses to find out if and when they will switch to the one pill a day. There will always be some exceptions, but by this time next year the Health Minister expects that 80% of all patients will be on the new formulation”.

The rollout of the FDC therapy will be in two phases. Starting in April, the Health Department will introduce it to HIV-positive pregnant women, patients who will be newly-initiated on ARVs and those who are co-infected with TB and HIV. Patients who are already taking their treatment will start to be switched to FDC therapy in July or August.

Abdullah noted that within SANAC there were some people who wanted everyone to start at the same time, but there was an understanding that the roll out will be phased.

“We appreciate the move by our government to introduce the FDC. But the government should equally put more efforts and ensure that we all get the same treatment”, said Mluleki Zazini, chairperson of the PLHIV sector.

Nevertheless, Zazini urged all people living with HIV who are affected by the phasing in approach to “be patient and continue taking the three pills a day, considering that their health will be compromised if they default”.

There are currently about 1.9 million patients on ARV treatment in South Africa.