What does HIV look like in South Africa?

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This requires that 90% of all people living with HIV will know their status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression.

While the country is tracking well with the first two requirements, we are not quite at the virally suppressed target, said Dr Moeketsi Mathe at Cipla’s HIV/Aids workshop recently.

He emphasised the importance of adhering to treatment regimens to maintain viral suppression, referring to the U = U (Undetectable = Untransmissable) premise. When a person living with HIV is taking HIV drugs and their viral load has reached undetectable levels (not enough HIV in their bloodstream for a test to measure), that person cannot transmit HIV to a sexual partner who is HIV-negative.

“However, undetectable doesn’t mean no virus. U=U is only true if the first U is true,” he said.

He said this often fails because of what he calls Mathe’s Rule of Seven:

1. Not taking treatment properly
2. Not taking treatment properly
3. Not taking treatment properly
4. Tuberculosis
5. Drug resistance
6. Patients taking other substances. He cited an example of one of his patients, whose CD4 count went up even though she was adhering to treatment guidelines. After some investigation, Mathe found that she was drinking green tea, which was affecting the drugs’ effectiveness.
7. Pills only work if you swallow them

Mathe said that in the past, patients were motivated by the fear of dying, and specifically leaving their children without a parent, and therefore took their antiretrovirals religiously. Now that HIV has been reduced to a chronic disease, people want to live a normal life, which also affects treatment adherence.

New triple-combination ART

The workshop took place on the same day that Health Minister Dr Zweli Mkhize officially launched South Africa’s rollout of the new triple-combination first-line HIV antiretroviral treatment (ART), referred to as TLD, a combination of tenofovir, lamivudine and dolutegravir (DTG). As a result of its multiple benefits (namely improved tolerability and higher barrier of resistance of the virus due to the drugs in the combination pill), the South African government is transitioning patients from TEE (tenofovir, emtricitabine and efavirenz) to TLD.

DTG, an integrase inhibitor approved in the United States by the Food and Drugs Administration (FDA) in 2013, results in the reduction of circulating HIV virus in the blood.