SA HIV Clinicians Society 12-06-07

 

SA HIV Clinicians Society, Press Statement, 12 June 2007

On interrupting antiretrovirals and other HIV-related drugs

The South African Public Sector strike has meant that many public sector patients with HIV may or already have had their treatment interrupted. This applies to antiretrovirals, as well as opportunistic illness treatment.

Interruption of treatment should be dealt with in the following manner:

· Try not to interrupt treatment if at all possible. If the dispensing clinic is not functional, patients should go to their nearest GP or pharmacy with their empty medication bottles, and request a repeat prescription from a private pharmacy. This may be costly, but the strike may be over soon, and a single month of treatment may be sufficient. Generic can be safely used to decrease cost.

· Should interruption be inevitable, stop all drugs on the same day (if in a controlled environment, nucleoside analogues can be continued for 5 days to cover the efavirenz or nevirapine ‘tail’). Ensure that the person is restarted as quickly as possible. Consequences of stopping antiretroviral drugs include continued immune deterioration, so people with low CD4 counts should make every effort to restart immediately once clinics become functional again. Restart medication at prescribed doses as soon as it is available: do not increase or double doses to make up for missed medication.

· Successful ART requires three drugs. Patients who have run out of one or two of their antiretroviral medicines should NOT continue taking the others, in order to avoid the emergence of drug resistance.

· If the person can not afford treatment, every effort should be made to attend a functional clinic elsewhere, again with medication bottles so that the clinic staff can confirm doses and formulations.

· Patients who require initiation of antiretrovirals may find this is delayed. This is obviously not ideal. Clinicians in the public sector will need to weigh starting antiretrovirals without the necessary support systems against continued risk of illness in the face of progressive immunosuppression.

· Patients should be counseled not to decrease dosages so as to make medication last longer. This will increase the possibility of resistance. Dosing should remain the same, till the tablets run out.

Patients and caregivers should stay in telephonic contact with their public sector clinics, if possible. Some HIV clinics are running emergency dispensing services, and patients may be able to get medication in the interim.

Issued by: The Southern African HIV Clinicians Society (See http://www.sahivsoc.org/)

Queries:

1. Dan Pretorius PretoriusD@alp.org.za

2. Dr WD Francois Venter, FCP (SA), Clinical Director, HIV Management Cluster, Reproductive Health and HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa

E-mail fventer@rhru.co.za