The Specialist Forum Volume 13 No 11 November 2013 | Page 12

HIV/AIDS

Survival curves on
ARTs still improving
Dr David Spencer, head of the Adult Antiretroviral Programme, Right to Care

T

wenty years ago, 25%-35% of South African infants born to
infected mothers became HIV positive. That rate has dropped
to 2%-5%. Life expectancy has increased. Survival curves on
antiretrovirals (ARTs) in the developed world now approximate the uninfected. Survival in the developing world is improving. Local researchers
estimate that a South African woman at 20 years with a baseline CD4
?200c/mm3 and on ART therapy can anticipate an additional 43.1 years
(95% CI 40-1-46.0) of survival (Johnson et al).
ART reduces transmission. Approximately 96% of uninfected partners of infected persons remain HIV negative when
their infected partner takes medication reliably (Cohen et al).
When large numbers in a community do so, the ‘community viral load’ falls, as does the spread of the virus in that community.
ART treatment becomes prevention. South African researchers have
confirmed a significant reduction in community viral load in Cape Town
and Johannesburg from 2004-2010 (Carmona et al). Fifteen years ago,
the daily ARV pill burden exceeded 20 tablets. Fixed-dose-combination
(FDC) tablets now promise control with just one pill a day.

Fixed-dose combination ART
The first available fixed-dose, once-a-day combination has been atripla.
This three-in-one pill incorporates two nucleoside reverse transcriptase
inhibitors (NRTIs) and one non-NRTI (NNRTI), namely tenfovir (TDF)+ emtricitabine (FTC)+efavirenz (EFV). It was registered in the US in 2006 and
entered the South African market in 2009. Three generic equivalents are
Table 1: The Advantages and Disadvantages of Fixed-Dose
Antiretroviral Combination Therapy. (Courtesy of the SA
Department of Health, 2013)
Advantages of FDC ART

Disadvantages of FDC ART

Grea ???????????????)???????????????????)?????????()??????????????????????????)?????????????????????????????)?????????()????????????????)??????()???????????????????????????)???????????????????????????????)???????????????????????????????()?????????????)???????????????????????)????????????????()X???????????????????????)????????????????????????????????)???????????????99IQ$??????????)?????????()??????????????????)??????????????????)??????????a????d?????????)????????()Q??????????????????????)??????????????????????????(??????????????????????????????)??????????????????????????????)?????????????????????????????()
?????????????9??????)!????? ?????Q????????)???????????H?????)????????????????()??????????????????????????????????????????????????????????)????!%X??????????????????)Q?????????????????????????????????????????????H????????????)???????????????????????????????!??????? ????????????????)??????????????????????????]?????????????????????????????????????????????????????????????????]???????????????????????????)?????????????????????????????????????????????????????]???????)???????????????????????????????????????????????????Q????????????)Q???? ????????????????????????????????????????????????)9??????????????????????????????IP??????????????????)Q?????????????????????????????????????????????????????)??????????????????
????????????????????a??????????d????)????????????????????????????????????????Q????#?e??????????)??????????????????????????????????????????????????)???????????????A??????????????????????????????????????????????()%YH??????????????????????????!%X???????????)M???????????????????????????????????????????????????%YI???)????????????!%X?????????????????????????????????????????)Q?????????????????????????????????????????????????????????QX?????????????????????????????????????????????=??)?????????????????????????????????????????????????????)??????????????????????????????????????????????????????????)?????????????????UL???????????????????????????????????)??????????????????????????????????????????????????????)%YH??????????????????Q?????????????)Q??????????????????????????????%YH?????????????)???????!%X??????????????????????????????????????????Q???)?????????????????????????????%YH??????????Q???????????)??????????????????????????!%X????????????????????????)%YI???????????????????????????????????????????????)???????????????????????????????????????????????????????)???????????????????????????????????????????????????)A??????????????????????QX????????????????????????(???????????????!%X??????????????????????????????????????)?????????????!%X??M!%X??????????????????????????????????)?????????????????????????????????????????????!????)?????????????????????????????????????????????????????????)??????????????????1????????????????????????????????????????)??????????)Q???????????????????????????????????????????????)?????????????????????????????????????????????????Q????????)????????????%YH????????????????????????????????????????????Q???????????????????????????????????????????)%YH???????????????????????????????????????????????)
???????M????)4??I??????H??Q?????IL??M???????@??5??????A54?)9???????T??5?9???????)4??!??????I4??????
P??5?????4??!????? ?)-???A??%????????????????????????????????????????????????????????????????????????????????????????!%X???????????)A???????????????9???????????????M????????????()A??????$$$$$$$$$$()9????????????Q???M????????????((0