SA faces major ARV resistance

South Africa is facing the possibility of state Aids patients developing "major resistance" to currently prescribed antiretroviral (ARV) drugs, Health Department director-general Thami Mseleku said on Thursday.

"The challenge is going to be huge because of the cost; it's 500% more... to move to the second-level regimen of drugs," he told a Parliamentary media briefing.

Mseleku was responding to a question on whether he thought the Health Department was facing a serious problem with people not completing their prescribed ARV treatment.

"The impression at the moment is that it's not many people who would necessarily not complete their treatment, but it's a significant number.

"We have a number of challenges... for the number of people who started treatment a long time ago, they are now faced with a situation where they are likely to be developing resistance anyway, and would have to move to the second level of drugs. That in itself is a problem of resistance.

Second-level regimen

"Then you have those people who actually stop and go, as it were, and that also creates problems of resistance.

"If we talk in general, we are facing the possibility of a major resistance phase in the country, which we need to respond to by changing... to the second-level regimen."

Mseleku was unable to put a figure on how many patients had fallen off the department's treatment programme, blaming this on "systems issues".

Existing figures were not "useful", and could not be presented comprehensively.
"We're trying to compile them now," he said.
Earlier, he said an estimated "cumulative total" of 300 000 people had started ARV treatment at government facilities by the end of June this year.

"These are figures that are in the public sector... but if we added (private sector figures) we would go to about 500 000."

Asked if the department was currently trying to source second-line ARVs ahead of any possible resistance phase, Mseleku said: "In preparation... we are in discussion with a variety of companies that may actually be able to provide these."
He said the department was confident it could reach a point in these discussions with the pharmaceutical companies where the price of the required drugs was "reasonable".

"But the challenge will be huge of course. Some of them are not necessarily drugs that are available readily in South Africa, and therefore we'll have to go through a whole range of processes of registration," Mseleku said.