#HIVToday: SA prepares to roll out new HIV treatment plan for children
14 Mar 2023
From April 2023, HIV-positive children from as young as four weeks and as old as 10 years will be able to go on a new treatment plan that includes the antiretroviral (ARV) drug, dolutegravir.
Source: Supplied. Juliet Houghton, the chief executive officer of the Southern African HIV Clinician’s Society (SAHCS).
The child-friendly treatment is a four-in-one capsule with strawberry-flavoured granules.
The treatment - approved by the South African Health Products Regulatory Authority (Sahpra) in June last year - will replace the syrup currently being administered at private and State hospitals.
The syrup allegedly tastes bad, and anecdotal evidence suggests it has often resulted in children not getting the full dose of medication because their tendency is to spit it out.
The new capsule can be opened and the granules dissolved in water or sprinkled over soft food, and need only be taken once a day.
Nurses will be given directives on the new medication, its side effects, and how to administer it. These directives are outlined in a set of proposed 2023 treatment guidelines that the Southern African HIV Clinicians Society previewed and unpacked in a Bhekisisa webinar.
Represented in this forum was the Southern African HIV Clinicians Society (SAHCS) together with the National Health Department and the Treatment Action campaign. The speakers included Juliet Houghton, chief executive officer of the Southern African HIV Clinicians Society; Jeremy Nel, president of the Infectious Diseases Society of South Africa, and James Nuttall, president of the Southern African Society for Paediatric Infectious Diseases.
Best practice for patients living with HIV
"The guidelines are about making sure that we have documents that are evidence-based, that help us to manage any disease in a standardised way," said Houghton. "We look at all the research that's available, we capture the best evidence and then collaboratively produce guidelines that basically inform how we provide care to patients living with HIV.
“The other element of guidelines is that we're able to educate not only the health workers that are going to administer them, but also wider communities and organisations so that everybody knows what's available, what's best practice and what we can do within any setting."
We are extremely grateful for this opportunity, #SAHCS nurses have also received a printed copy thanks to the generosity of @GovMonaco and @DNDi making this possible, the drug dosing chart is available here https://t.co/wPKFBOqDVr https://t.co/TH8b0IBJva
— Southern African HIV Clinicians Society (SAHCS) (@SAHIVSoc) March 3, 2023
Said Nel: “The reason for the Southern African HIV Clinicians Society updating its guidelines is that we want more people [living with HIV] to be switching to TLD - a fixed-dose combination of tenofovir, disoproxil, lamivudine and dolutegravir."
This means that adults, along with children who are HIV positive, will have access to the new medication.
Nel added that because the public and private healthcare sectors cater for different markets, they each have their own guidelines, but despite this, patients can be assured they will get standardised care across facilities.
“The roll out of TLD across both private and State hospitals will be a milestone achievement in improving health outcomes for all living with HIV," he said.
What's different about the new medication?
"TLD is the best tolerated medication anywhere in the world and is affordable.
“Across the board for adults and children, TLD is more potent, suppressing viral load quickly. It is better tolerated with fewer side effects and lower overall incidence of adverse events, and is associated with fewer drug interactions. This means that compared to other regimens, it is easier to administer TLD with most commonly used medications.”
If you're taking this drug, it's also very unlikely that you're going to develop resistance to it. This is really a key advantage of this regimen, he said.
"HIV is a very hard disease to control because of the adherence to antiretroviral medications. Dolutegravir [in the TLD] is more forgiving of skipped doses, reducing patients’ risk of developing drug resistance."
From next year, SAHCS will recommend dolutegravir not only for patients who start taking ARVs for the first time, but also for second- and third-line treatment.
The potential to stop paediatric HIV in its tracks
That dolutegravir will remain a component of the new treatment plan for HIV going forward, has been applauded by those in the industry.
The health department started to gradually phase dolutegravir in December of 2019. Dolutegravir is currently one of the ARV drugs in a three-in-one pill for first-line treatment. The other two drugs in the pill are tenofovir and lamivudine.
"Belonging to a group of ARVs called integrase inhibitors, dolutegravir is said to be more effective at lowering the viral load of HIV in the blood, and is so effective that it is said a person living with HIV is no longer able to pass on the virus to a partner during sex," added Nuttall.
"Similarly it works at protecting unborn children from having the virus transmitted to them during their mother's pregnancy."
"With this new medication, we could potentially no longer have paediatric HIV," said Nel.
"But - I don't think we'll get there."
This was a sentiment echoed by Houghton, who said South Africa faces significant resource limitations.
"And yet, it's important to know that paediatric HIV is a preventable condition," Nel continued.
"Consider that there are still 1.7 million children who are currently living with HIV globally, and yet only about 50 million have access to treatment," Nuttall said. "We know that this lags behind adults, and that there are still new children coming through the system who need diagnosis and treatment."
A crucial intervention is to stop mother to child transmission. "One of the key things is to make sure that pregnant women who are HIV positive are virally suppressed in the best possible way," Nel said.
"The answer to that, at the moment, is TLD."
