Antiretroviral therapy treatment for HIV in Africa

Antiretroviral Therapy (ART) is defined by UNAIDS as a mixture of antiretroviral (ARV) drugs that help reduce the risk of transmission of HIV by 96% (4) as well as stops the progression of the disease. According to The World Health Organization (WHO), ART also reduces the risk of HIV infected individuals being further infected with Tuberculosis (2). Various types of ARV drugs act in different stages in the HIV cycle. A combination of ARV drugs as treatment for HIV/AIDS is known as Highly Active Anti-Retroviral Therapy (HAART).

UNAIDS has found that antiretroviral therapy has reduced the risk of HIV infected individuals contracting tuberculosis by 65% (5). ART has helped save the lives of 5.5 million people in low- and middle-income countries throughout Africa – Sub-Saharan Africa has benefited the most (1). In 2013, the UN expanded the guidelines which allowed more people to become eligible for the treatment. This in turn allowed people with HIV to return to work much more quickly, and furthermore boosted productivity and helped in the fight against poverty (1).

While these benefits are great, a team Liverpool School of Tropical Medicine conducted a study on ARV drug use in Africa and have found that certain themes arise as to why patients may not want to dive into this treatment head first. Although the use of ART helps the economy circulate (6), people who have contracted HIV face certain obstacles that prevent them from getting the medications they need. Within their communities, they are faced with stigma, financial issues, and unpredictable life events. Another theme that arises is that the healthcare system may come across as intimidating and thus may discourage people from getting the care that they need. The last notable theme is that people do not want to commit long-term to the drugs. Dr. Ingrid Eshun-Wilson, the lead author, says that patients typically cycle in and out of care due to this implication (3). UNAIDS also shows the disparities between the amount of eligible people for the treatment and those who actually undergo it: 59% of people with AIDS in Eastern and Southern Africa undergo treatment, 79% in Western and Central Africa, and 89% in North Africa, creating a 66% overall global average gap (1).

References:

1. UNAIDS, Report on the global AIDS epidemic, 2013. UNAIDS; Geneva, 2013, https://www.unaids.org/en/resources/documents/2013/20130923_UNAIDS_Global_Report_2013
2. “Universal antiretroviral therapy (ART) for all HIV-infected TB patients.” World Health Organization, World Health Organization, https://www.who.int/hiv/topics/tb/art_hivpatients/en/
3. Liverpool School of Tropical Medicine. (2019, January 11). Being HIV positive and staying on antiretroviral therapy in Africa. ScienceDaily. Retrieved January 23, 2019 from www.sciencedaily.com/releases/2019/01/190111095119.htm
4. Cohen MS et al. (2011). Prevention of HIV-1 Infection with Early Antiretroviral Therapy. New Eng J Med 365:493-505.
5. Suthar AB et al. Antiretroviral Therapy for Prevention of Tuberculosis in Adults with HIV: A Systematic Review and Meta-Analysis. PLoS Med, 2012, 9:e1001270.
6. Walensky RP et al. Cost-Effectiveness of HIV Treatment as Prevention in Serodiscordant Couples. New Eng J Med, 2013, 369:1715-1725.