hiv261101

ANTI-HIV DRUGS AVAILABLE IN KENYA

 AYAKI

What is this? AIDS, AYAKI, SIDA, MATIEKA, SLIM UKIMWI!

  • Kenya can manufacture, import HIV/Aids drugs
    By Othello Gruduah

    Kenya became only the second country this year, after South Africa, to pass a law legalising generic versions of patented drugs against HIV/Aids. This, not long after President Moi declared the disease a national disaster, came as a relief to thousands of poor Kenyans who have been infected by the lethal virus but who cannot afford the high cost of treatment.

    On June 12, Parliament unanimously passed the Industrial Property Bill, 2001, allowing for the parallel importation and manufacture of generic antiretroviral drugs, particularly, Aids drugs. At the time, Trade and Industry Minister Nicholas Biwott said the Bill was “a big issue” within the World Trade Organisation (WTO) of which Kenya is a member. He clarified that contrary to popular belief that the Bill was meant for Aids drugs only, it had 101 sections dealing with issues of innovation, intellectual property and biotechnology prowess.

    Biwott emphasised that the Bill seeks to create commercial value out of skilled individuals. Public Health Minister Sam Ongeri noted, with concern, that the Sh12 billion needed to purchase Aids drugs was beyond the Sh9 billion annual budget allocation to his ministry. He added that the antiretroviral drugs needed by Aids patients cannot be imported and distributed free of charge because of their exorbitant costs. Describing Aids as a national catastrophe, the Minister vowed that the government could not sit back and watch its population ravaged by the scourge.

    In publishing the Bill the government sets out that the object of the Bill is to repeal and replace the Industrial Property Act (Chapter 509 of the Laws of Kenya). The Act which it is seeks to repeal and replace is the statute currently concerned with the registration and protection of the intellectual property rights in patents, utility models, industrial designs and rationalisation models, it said. The need to repeal and replace the Industrial Property Act, according to the Bill, arises from a multiplicity of developments in intellectual property law on the international scene, including a number of treaties and agreements to which Kenya has been a party.

    The Bill, it is said, seeks to modernise an important part of Kenya’s regime of intellectual property law and bring it into conformity with the said international instruments. “Kenya is a party to the Paris Convention for the Protection of Industrial Property. However, a number of provisions of the Industrial Property Act relating to the expiry of patents, proceedings for their forfeiture or revocation and application and grant of compulsory licences are inconsistent with this Convention. “The Bill replaced this by repealing those provisions and introducing others which are consistent therewith,” said the government.

    As a member of the WTO, it pointed out, Kenya is required to amend her intellectual property legislation to conform to the agreement on Trade Related Intellectual Property Rights (TRIPS Agreement). The Bill addresses fully the requirements under the TRIPS Agreement, according to the government. “Similarly, following Kenya’s accession to the Patent Co-operation Treaty, it has become necessary to make some provisions in order to bring the statute to conform with this treaty. The volume and extent of the amendments required to the Industrial Property Act make it more convenient to repeal and replace this Act altogether,” it emphasised.

     

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    Make Aids drugs accessible, firms told

    Aids activists around the globe hope that the UN Global AIDS Summit, held at the end of June, will inspire a host of integrated responses - from governments, businesses, and civil society groups - to the global Aids crisis. Leading up to the Summit, the Kenyan Parliament became the second government in the world to pass into law legislation that will make it easier for the country to import or manufacture generic versions of patented medicines. Coca-Cola offered its trucks in the delivery of Aids prevention and treatment supplies across the African continent. On June 22, members of the Interfaith Center for Corporate Responsibility (ICCR) issued a press release that demands that the pharmaceutical companies do more to combat Aids globally. On the eve of the United Nations Global Aids Summit, religious organisations associated with the International Health Issue Group of the Interfaith Center on Corporate Responsibility (ICCR) called on pharmaceutical companies to make life-saving HIV/Aids medicines accessible and affordable in African countries, where Aids is raging at pandemic levels.

    “Pharmaceutical companies are profit makers but they also have the unique mission to provide health giving medicines, often making the difference between life and death,” explained Sr. Barbara Aires of the Sisters of Charity of St. Elizabeth, New Jersey. “This is the time for pharmaceutical companies to offer the kind of leadership necessary to address this disease that afflicts so many people throughout the world and especially in Africa,” declared Rev. Seamus Finn of the Missionary Oblates of Mary Immaculate, a member of ICCR. “These companies can galvanize the response of other corporations, governments and organisations that want to do something to address this crying human need.” “Many ICCR members have workers in Sub-Saharan Africa and sister relationships with religious and aid institutions in Africa,” explained Patricia Zerega of the Evangelical Lutheran Church in America. “We see first hand the ravages of the Aids pandemic and know affordable drugs could save millions of lives.” ICCR, a coalition of 275 Roman Catholic, Protestant and Jewish institutional investors, including denominations, religious communities, pension funds, dioceses and health care corporations, encourages pharmaceutical companies to develop systemic and comprehensive solutions to the Aids crisis.

    HIV/Aids newly infects four million men, women and children each year in Africa. Most African countries can afford no more than $10 a year per citizen on all health care. The best-discounted prices for drugs to combat AIDS averages $365 yearly per person. UN Secretary General Kofi Annan has called for creation of an Aids Health Fund, administered by the World Bank, to create an adequate pool of money to support the efforts of countries and organisations in their response to this great suffering. “In addition to donating medicines and funds to the UNAIDS Fund,” continued Fr. Finn, “ICCR members are pressing companies to increase investment in research on new vaccines to combat HIV as well as TB and malaria and refrain from blocking access to generically manufactured drugs in countries that cannot afford the drugs marketed by patent owners.” According to Sr. Aires: “ICCR members applaud the drug companies’ decision to negotiate an agreement on the recent legal action introduced by pharmaceutical companies on the South African Medicines Act.” Sr. Aires refers to a suit 37 companies filed in South African courts, arguing that the purchase of cheaper generic versions of anti-AIDS drugs violates their intellectual property rights.

    ICCR members also are challenging drug-pricing policies of pharmaceutical giants, most of which were plaintiffs in the suit. ICCR members have sponsored shareholder resolutions to Bristol-Myers Squibb, Eli Lilly, Johnson & Johnson, Merck, Pharmacia, Schering Plough and are in dialogue with American Home Products, Abbott, Pfizer and the British company GlaxoSmithKline.

    · Courtesy Global Concerns
     

     

  • Microbicides could buttress the war on Aids
    By Nancy Mburu

    With almost 34 million people world-wide living with HIV/Aids, scientists have realised the need to develop additional prevention options before an Aids vaccine can be made easily accessible.

    More than 90 per cent of new infections are spread through unprotected sex. Due to gender inequality, condoms are simply not a feasible option for many women who are biologically more vulnerable to HIV and other sexually transmitted infections (STIs) than men.

    The female condom has been a good option for some women, but it is not widely available and its effectiveness in preventing other STIs is not clear. All these factors have created the need to develop a prevention method that women can control and hence save millions of lives.

    This has led to the creation of the microbicide - a product that would be used vaginally by women to prevent infection. If successful, microbicides would offer women the potential to protect themselves and their sexual partners against HIV and other STIs.

    According to a document by Population Council, titled The Case of Microbicides: A Global Priority, there has been significant progress in microbicidal research and development over the last 10 years.

    Researchers plan to have a microbicide that would be available in a variety of preparations, as well as in both contraceptive and non-contraceptive forms. Microbicides, it is expected, would increase protection when used in addition to condoms, and could provide back-up in cases of condom failure.

    There are a number of different microbicide products currently being tested by various researchers and, according to Kenya Medical Research Institute (Kemri), they include;

    • Buffer gel or Acidform that works by making the natural pH of the woman’s genitalia too acidic for HIV to survive, hence countering the alkaline environment that is created by semen.
    • Carageenan, a substance which coats the woman’s genitalia to prevent HIV transmission.

    Population Council gives others as:

    • Spermicides like Nonoxynol-9, Octoxynol-p and Menfegol, which are detergent-like chemicals that disrupt the lipid membranes of cells and envelops (surface) of HIV. They kill or inactivate infectious pathogens.
    • Anti-retroviral agents like PMPA gel, which prevents HIV from replicating in cells, and plantibodies - anti-HIV antibodies genetically engineered from plants that would combat pathogens before infection occurs.

    It is evident that microbicides, if proved effective, could provide couples with a wider range of methods to choose from in order to prevent HIV and STIs.

 

  • SA’s anti-retroviral Aids drugs great controversy

    President Thabo Mbeki has become a bully when it comes to Aids, parliamentary insiders say. He seldom speaks about the killer disease and when he does, many wish he hadn’t. Out of the public eye he’s putting pressure on politicians and researchers to toe his controversial line. Respected -and well-connected - journalist Charlene Smith speaks out.

     

    There’s a deep feeling of resentment and a growing anger among our parliamentarians. They spend endless days thrashing out budgets for education, health and the economy yet the one thing that affects them all - the monster that’s slowly destroying South Africa is hardly tackled at all.

    Aids, Department of Health figures say, is killing 700 people a day in South Africa, yet it’s not high on President Thambo Mbeki’s agenda. When he does bring it up, he’s so controversial MPs find his speeches even harder to bear than his silence - especially as many of them are the direct victims of his policies. But because he’s their leader they’re powerless to speak out.

    A senior ANC MP claims four MPs have died of Aids so far this year. Their names haven’t been revealed to protect their families. Those in the know say at least 20 per cent of our MPs are HIV-positive. They claim at least 10 per cent of those - about 45 people - are taking anti-retroviral drugs (ARVs) which delay the onset of Aids. Others are buying them for infected relatives on their government medical aids.

    They’re all too aware the disease is decimating our population. When they step out of parliament in their designer clothes they go to villages and townships at the weekends where there are endless funerals.

    “I sit in parliament and look at those who’re getting thin. A few months later they get the puffiness that comes with using anti-retroviral drugs and I think, ‘Ah yes,’ “ says an opposition parliamentarian.

    Yet the president refuses to pass a law allowing ARVS, the only lifeline for HIV victims, to be distributed to HIV positive people. He also won’t sanction them for pregnant mothers who could pass the virus to their children. Two weeks ago, despite his promise to stay out of the Aids debate in future, he told parliament ARVs were “toxic”. And despite 20 years of expert scientific research to the contrary, he still doesn’t believe HIV causes Aids.

    “So why are the drugs toxic for ordinary people and not for members of parliament?” opposition MP Patricia de Lille asked Mbeki after his anti-ARV speech.

    It’s a good question, especially as Mbeki has just ordered a new presidential jet for R500 million enough to pay for ARVs for 2.5 million pregnant women. This would stop about 1.6 million babies getting HlV

    It became clear just how frustrated parliamentarians are at not being able to speak out when ANC MP Ruth Bengthu told parliament earlier this year her daughter Nozipho was HIV positive. “Afterwards I was inundated with calls from MPs who were either HIV-positive themselves or had relatives who were,” she says.

    Some MPs talk about resigning. Others say: “I would resign but I have children in school. What other job could I get?”

    The level of debate around Aids in government circles isn’t of a high standard. Most MPs are too afraid to open their mouths. When Health Minister Manto Tshabalala-Msimang questioned a small aspect of the president’s Aids theory at a cabinet meeting three months ago, an insider said: “He tore her apart. It was the most terrifying barrage of anger to watch.”

    When Anglican Archbishop Njongonkulu Ndungane said South Africa was in danger of becoming a banana republic because of its failure to deal with Aids he was summoned to Pretoria, where Mbeki read him the riot act, Afterwards the archbishop said: “The president is an insecure man.”

    Before his death then presidential spokesman Parks Mankohlana also found himself in hot water. In June last year he told an American scientific journal the government felt caring for Aids orphans was too expensive and it was better to let Aids babies die. There was a world-wide outcry, and Mankah-lana subsequently denied his comment but he’d been recorded on tape.

    Mankahlana died last October of what many claimed was Aids. There were rumours a senior politician had ordered him and another prominent young ANC leader to stop taking ARVs. The other ANC leader is now allegedly taking a herbal remedy.

    There are men and women who are deeply concerned. Last week Finance Minister Trevor Manuel bypassed Mbeki’s reservations and used his mid-term budget to significantly increase spending on fighting Aids.

    Archbishop Desmond Tutu has also taken a stand, “I’m glad the trade unions and the religious community have teamed up to say ‘Lets stop fiddling while our robe is burning’ on HIV/Aids,” he said on SABC’s Newsmaker programme. “Discussing whether this is or that is the cause... that’s a luxury we can’t afford. Let’s stop playing marbles and roll up our sleeves and invoke the spirit that inspired all of us to win the struggle against apartheid. HIV/Aids, poverty and crime are the new enemies in South Africa.”

    But it’s a view apparently not shared by Mbeki. Another huge row erupted over his questioning of a recent Aids report released by the Medical Research Council (MRC), one of the most respected medical research organisations in the world.

    First the report was delayed for a month while Mbeki disputed its Aids mortality figures. He based his counter-argument on five-year-old World Health Organisation figures he pulled off the Internet, somehow missing the more recent statistics (see boxed text). His penchant for disputing scientific evidence after late night Internet trawls has become a joke in some quarters.

    There was more controversy last month when the parliamentary subcommittee on the status of women met to hear the MRC’s testimony on HIV and women. First the sub-committee was pressured to cancel the hearings. Then the MRC’s Dr Malegapuru Makgoba decided not to testify at the last minute, causing rumours he too had come under government pressure.

    The government has also threatened three times to withdraw the MRC’s funding if it does not toe the ANC line on Aids. 60 per cent of the MRC’s funding comes from the government.

    The MRC report has found about 236 000 South Africans have full-blown Aids and HIV among pregnant women has increased by 24 per cent since 1990. It also states Aids causes 40 per cent of the deaths of South Africans aged between 15 and 49

    Despite this Mbeki told BBC interviewer Tim Sebastian he felt South Africans were more likely to die as a result of violence than from Aids.

    Two years ago there was also a row over Virodene, the only medication Mbeki considers an acceptable Aids treatment. It’s made from the industrial solvent dimethylformamide, which has been banned for human use in South Africa and elsewhere because it has dangerous side effects.

    A few years ago human trials of Virodene took place before the Medicines Control Council ( MCC) had given permission and the case eventually ended up in court. Trials were suspended but not before it had emerged a stake in Cryopreservation Technologies, the company that produced the controversial drug, had been sold to former Umkhonto weSizwe cadre Ngelezi Zaccheus Mngomezulu.

    Allegations of ANC involvement were made in parliament and the row grew to such proportions Mbeki took the unprecedented step of writing a 1400-word article explaining why he had intervened directly in the Virodene fiasco. He attacked detractors of Virodene, suggesting its researchers had been pilloried. “Those who seek the good for all humanity have become the villains of our time,” he said, adding the ANC had never been involved in any financial arrangement related to Virodene. Meanwhile the Aids crisis in South Africa continues to worsen. And grassroots reports on the frightening reality are pouring in from all quarters.

    Statistics tell the brutal truth about HIV - it’s killing our country, As Archbishop Tutu says, it’s time to stop playing marbles. We beat apartheid. Now it’s time to beat Aids.

    · Courtesy SA You Magazines’ November 8, 2001

 

  • The anti-HIV drugs available in Kenya

    There is no drug that has managed to eradicate the Aids virus after someone is infected. However, there are drugs that can prevent the virus from multiplying.

    The disease Aids arises because of destruction of cells important for fighting diseases in one’s body. This destruction is mainly due to an increase in the amount of viruses circulating - viral load.

    If the amount of viruses is low, the body’s protective cells (CD4+) are not seriously destroyed and a person can continue to enjoy a longer life. Anti-HIV drugs currently in the market therefore keep the virus load low.

    The bad news is that once you start on the drugs, you should continue using them for as long as you live, or until medical science finds an alternative.

    There are three classes of anti-HIV drugs in the market, which have been classified according to the part of the virus that they attack.

    It is recommended that these drugs have to be taken in combination for it has now been confirmed that the more the sites of a virus attacked, the less chances there are of the virus outsmarting one drug - resistance.

    This article is a review of the type, cost, dose, and potential side effects of two classes of anti-HIV drugs currently available in Kenya. It is emphasised that these are all prescription only medicines, and the advice of a physician should always be sought before purchasing the drugs.

     

    Zidovudine (AZT)

    Zidovudine is manufactured by Glaxo Wellcome. Approved in the US in March 1997, it was the first authorised anti-retroviral for management of HIV infection. In Kenya, AZT is marketed by Glaxo Wellcome but is found in retail outlets in major pharmacies.

    The type commonly marketed in Kenya is in form of 100mg capsules. A packet usually has 100 of these capsules. A patient takes two capsules three times a day without any regard to meals.

    The recommended retail price per packet is Sh9,341 (approximately Sh94 per capsule). Hence a one-month dose costs Sh16,920.

    Unfortunately, because of the high resistance developed by HIV virus to this drug, it is recommended that AZT must be taken in combination with another anti-retroviral drug.

    Pregnant mothers who are HIV positive may take AZT alone starting at the eighth month of pregnancy so as not to pass the HIV virus to their unborn child. The recommended dosage for a HIV positive pregnant mother is three capsules twice a day until the beginning of labour.

    When labour starts another three tablets every three hours is recommended until delivery. Side effects which may arise on taking AZT include headaches, fever, chills, tiredness and vomiting. Major outlets for AZT in Kenya are Glaxo Wellcome of Tel. 02-545871.

     

    Videx (DDI)

    Didanosine or DDI was cleared for use for treatment of HIV infection in the US in 1991. It is made by Bristol-Myers Squibb.

    Reports of viral resistance to DDI are rare. It is marketed in form of tablets of 100mg. Adults above 60kg body weight need to take four tablets once a day. While those below 60kg body weight should take three tablets once daily.

    The current average cost of one tablet of DDI is Sh166. Hence a one-month dose of 120 tablets will cost Sh19,920. DDI must be taken on an empty stomach or 30 minutes before breakfast. It is best dissolved in a glass of water or apple juice before taking it. This drug should be avoided by people with a history of heavy alcohol consumption. DDI is distributed in Kenya by Philips Pharmaceuticals of Tel. 02-823660.

     

    Zerit (D4T)

    Zerit, or stavudine, was approved in June 1994. Also made by Bristol-Myers Squibb, it is marketed in form of 40mg capsules. Adults with a body weight of 60kg and above take two capsules daily (one in the morning and one in the evening). It can be taken without regard to meals.

    The current average cost of one capsule is Sh389, one-month dose will cost Sh23,340. Potential side-effects of Zerit are headaches, and vomiting. Zerit is often taken in combination with DDI. Philips Pharmaceuticals market Zerit in Kenya, Tel. 02-823660.

     

    Epivir (3TC)

    Epivir or lamivudine came into being in 1995. This drug is recommended for use only when it is in combination with AZT or Zerit and a protease inhibitor (Crixivan, Norvir, viracept or invirase). This is because it quickly develops resistance.

    It is available as 150mg tablets. One tablet is taken twice a day. A combination form of 3TC and AZT is now available as one tablet called Combivir. Tablets of Combivir are taken one twice a day.

    The retail price of one tablet of 3TC is KSh189 and Combivir is Sh383 per tablet. Hence a month’s dose of 3TC alone will cost Sh11,340, while Combivir’s monthly dose would cost Sh22,980.

    Potential side-effects may include headaches, tiredness and muscle soreness. Glaxo Wellcome sells Combivir and 3TC.

     

    Hydroxy urea (Hydrea)

    The use of hydroxy urea for treatment of HIV infection came later than the above drugs. Its way of attack is different from the above for it inhibits the virus indirectly.

    Before its use in anti-HIV treatment, it had been used by patients with blood disorders for long periods of time. Prolonged studies with hydroxyurea has up to now revealed very little viral resistance.

    Hydrea is available as 500mg tablets. Patients take two tablets two times a day. The cost of one tablet is approximately Sh26. Hence a one-month dose costs Sh3,120.

    There are recommendations that hydrea should be taken in combination with DDI in patients who have not yet developed symptoms of Aids. Hydrea is manufactured by Bristol Myers Squibb and is marketed in Kenya by Phillips Pharmaceuticals.

     

    Nevirapine (Viramune)

    Manufactured by Boehringer Ingelheim, Nevirapine is a type of anti-HIV drug that does what AZT does but in a different way. A new study done in Uganda using Nevirapine has shown that it has a powerful effect in prevention of mother-to-child infection of HIV when taken by HIV positive pregnant women.

    Nevirapine comes in 200mg tablets. A patient takes one tablet at the onset of labour pains and within two days of delivery, the new born is given a dose. The cost of the treatment was equivalent to US$4 or Sh280. This drug has not yet been registered for sale in Kenya.

     

     

    Other anti-HIV include:

    Viracept

    Viracept is used in the treatment of people with HIV infection. Infection with HIV leads to the destruction of CD4 T cells, which are important to the immune system.

    After a large number of CD4 cells have been destroyed, the infected person develops acquired immune deficiency syndrome - Aids.

    Viracept works by blocking HIV protease - a protein-cutting enzyme, which is required for HIV to multiply. Viracept has been shown to significantly reduce the amount of HIV in the blood. You should be aware however that the effect of Viracept on HIV in the blood has not been correlated with long-term health benefits. Patients who took Viracept also had significant increases in their CD4 cell count.

    Viracept is usually taken together with other antiretroviral drugs such as Retrovir (Zidovudine, AZT), Epivir (lamivudine, 3TC), or Zerit (stavudine, d4T). Taking Viracept in combination with other antiretroviral drugs reduces the amount of HIV in the body (viral load) and raises CD4 counts. Viracept may be taken by adults, adolescents, and children 2 years of age or older.

    Viracept is not a cure for HIV infection or Aids. The long-term effects of Viracept are not known at this time. People taking viracept may still develop opportunistic infections or other conditions associated with HIV infection. Some of these conditions are pneumonia, herpes virus infections, mycobacterium avium complex (MAC) infections, and Kaporsi’s sarcoma.

     

    Procrit

    Procrit is used for the treatment of anaemia related to therapy with zidovudine in HIV-infected patients. Procrit is indicated to elevate or maintain the red blood cell level and to decrease the need for transfusions in these patients.

    Procrit at a dose of 100 units/kg three times per week, is effective in decreasing the transfusion requirement and increasing the red blood cell level of anaemic, HIV-infected patients treated with zidovudine.

     

    Combivir

    Zidovudine, one of the two active ingredients in combivir, has been associated with haematologic toxicity including severe anaemia, particularly in patients with advanced HIV disease. Prolonged use of zidovudine has been associated with symptomatic myopathy.

    Combivir is a fixed-dose combination of lamivudine and zidovudine. Ordinarily, combivir should not be administered concomitantly with either lamivudine or zidovudine.

    · Courtesy Kenya Medical
    Research Institute, and HIV Plus

     

     

  • Treatment without sensitivity tests a waste of time - study

     

    By ordering the test for me, my doctor saved my life,” says Jim Johnson, a 65-year-old retiree who was first diagnosed with HIV disease in 1987. Johnson, a San Franciscan who cares for himself at home despite diagnoses of Aids, colon cancer and diabetes, is talking about a relatively new tool called phenotypic testing that reveals what anti-Aids medications will work best for each patient.

    Dr Marcus Conant, Johnson’s physician, said the test is helping doctors to assess which drugs will work and which will not for individual Aids patients. The test is particularly important for people who fail conventional therapy, as Johnson had, added Conant, a professor at the University of California at San Francisco. Demonstrations show that HIV is better controlled in patients who undergo phenotypic testing than those who do not.

    The new test works by pairing each patient’s virus with various drugs intended to kill HIV and seeing how the particular strain reacts.

    Many of the major challenges involved in treating Aids centre on its tricky ability to mutate. HIV evolves quickly, so the virus strain in one patient may be completely different from another person’s. Also, as it changes form, the virus becomes resistant to the very drugs targeted at killing it.

    Moreover, resistance to one drug often confers resistance to others in its class. The test gives clinicians insight into how patients will respond to each drug. This, in turn, allows doctors to tailor treatment to the individual, giving a better shot at success. The test itself is painless. All the doctor needs is a blood sample, so he can isolate the Aids virus.

    Using sophisticated genetic techniques, the virus is grown quickly in culture and put in a test tube with each anti-Aids drug. Virus growth is then monitored. If growth is curbed, the drug is working. It’s that simple.

    After Johnson went to see Conant in 1992, he was prescribed what was then the typical Aids cocktail - AZT, ddI and ddC. But the San Franciscan retiree said he became “deathly ill”. Drug-related side effects - nausea, fatigue and other symptoms - were so severe that he wanted to stop taking the medication, even though he needed it to keep the levels of HIV in his blood at acceptable levels.

    That’s when Conant recommended the new test that could help determine what drugs would help him. Within weeks of taking the test and switching to a new regimen, he felt much better. Several years later, when the potent protease inhibitors were introduced, Conant prescribed them for his patient. Again, Johnson said he became ill. And again, the test guided them to a better regimen for him.

    Dr Thomas Quinn, an Aids specialist at Johns Hopkins University in Baltimore, said the phenotype test provides very important information for the management of Aids patients, especially those who appear to be failing on their current cocktail. His only reservations: the high cost, about $800, which only some insurers pick up, and the time it takes to get results due to a backlog - about one month.

    Genotype testing, which looks for genetic mutations that make a virus resistant to various drugs, costs about half as much and is faster. At the same time, people who have been infected for years and have taken many drug combinations may have such complicated genetic patterns that it is difficult to interpret them.

    The phenotype test, called Antivirogram, was developed by Virco N.M., a Belgian biotechnology company that partly funded the study. During the study, 218 patients whose doctors opted to change their regimen after they failed to respond to their initial drug cocktails were investigated. Half were randomly assigned to receive phenotypic testing, while the others got standard care without testing.

    After 16 weeks, 58 per cent of the patients whose new regimen was tailored in accordance with the results of phenotypic testing had HIV levels that had dipped too low to measure. In contrast, 37 per cent of those without testing did this well.

    Johnson continues to take five to six different anti-Aids drugs - two dozen pills three times a day. There’s also four drugs for gastrointestinal problems caused by the chemotherapy for colon cancer he was diagnosed with in 1994. And then there’s the insulin for his diabetes. But he remains upbeat. His latest regimen has been controlling his HIV levels for almost three years, with the virus undetectable on typical tests.

     

    - Courtesy Virco 1995-2000

 

  • Patients treated like consumers
    Nganga Mbugua

    Some time last year, South African President, Thabo Mbeki, came under a spot of trouble when he said that his government would not actively seek to give anti-retroviral drugs to pregnant mothers and other Aids patients. He argued that the drugs were not safe for pregnant women and that subsidising the cost for other patients would deplete the health budget so much so that it would be impossible for government hospitals to afford asprins for those with headaches.

    Mbeki also questioned the amorphous link between HIV and Aids, much to the chagrin of many Euro-American leaders and scientists who vilified him as a conspiracy theorist who had chosen to be misled by a small group of dissenting researchers who were doubting the existing theories about HIV and Aids.

    At much the same time, multinational pharmaceutical companies operating in South Africa were selling the assorted life-prolonging cocktail of drugs at exorbitantly high prices while opposing the production of cheaper generic drugs citing the controversial Intellectual Property Rights agreement as their defence. They even took the government to court only to back down and apologise after the public took to the streets to protest over the debacle.

    Of course, many readers are familiar with the politics of Aids history - from whether it is a naturally-occurring virus or man-made disease to whether it was linked to the 1969 polio vaccines and the US congress meeting that authorised US scientists to manufacture a germ for biological warfare in the 50s. For many, though, this is much water under the bridge.

    However, it is becoming increasingly evident that drug-manufacturing companies are treating the Aids pandemic in Africa and other developing countries as milch cows from which to reap bloated profits. They have ceased, as it were, to treat Aids patients as medical cases and are instead treating them like consumers of the cocktails of drugs whose cost is making nonsense of Africa’s war against poverty, ignorance and disease.

    Only a year ago, the cost of Aids drugs per patient per year in Kenya was way above the Sh250,000 mark. This meant that only a select few could afford to buy the drugs. The rest could only struggle to keep up with the high cost thereby depleting family and national resources in a bid to prolong their lives although we all very well know that Aids is a terminal disease and has no known cure.

    Today, thanks to the struggle waged by Aids campaigners, the government has agreed to amend the Intellectual Property Rights Bill to allow for the manufacture of generics which have brought the prices of Aids drugs to a low of Sh3,000 per patient in some local hospitals. In this dark hour, this is reason for celebration although the search for a cure or a vaccine remains the only hope for the affected and infected millions.

    Ironically, more emphasis is being placed on Aids awareness seminars and workshops even at a time when it has been shown that awareness does not necessarily mitigate the spread of the disease. In my view, part of the reason why donors continue to fund such seminars is that they compile a great deal of data - in the form of reports - which, I believe, are then passed on to multinational pharmaceutical companies as market intelligence. This, contributes significantly to the vicious cycle that Aids patients in particular - and poor governments in general - now find themselves in.

    Some readers will recall that shortly after the anthrax attacks in America left scores hospitalised, the American government struck a deal with some Latin American countries to produce generics to treat anthrax cases. The speed with which the deal was cut left no doubt that there is no political goodwill at the international level to come to the rescue of Aids patients in poor countries.

    Matters have not been made easier by the fact that European and American researchers who have been working in conjunction with Kenyan doctors, volunteers and Aids patients, have been too eager to patent the discoveries in a manner that leaves a lot to be desired and casts serious doubts as to their intentions and sincerity. In the event that such discoveries yield a vaccine or a drug, it would mean that only one of the parties would benefit from the proceeds while the African doctors and patients will be short-changed. Which, in effect, means that the poor nations will be unable to afford such drugs as they will be sold for huge profits by the “owners” of the patent rights.

    Unless poor countries reject such internationally binding legislations, and turn away from the “false cause and effect” researches on HIV/Aids, they will not make any headway in the fight against this pandemic. In the meantime, the multinational “drug barons” will continue to smile all the way to the bank.

  • Dealing with side effects of anti-retrovirals

    Intervention on HIV/Aids does not only entail using drugs to treat the opportunistic infections but also dealing with side effects of such drugs.

     

    Dealing with drug side effects can be a challenge for anyone. Every anti-HIV drug, as well as drugs that prevent and treat infections, has its own set of possible effects.

    These may vary from one person to the next. Some people experience few or no side effects at all, while some experience mild and manageable side effects. Others have quite severe side effects.

    The key to coping with side effects is knowing what to watch out for and having a plan in place to respond if problems occur. If a drug you are taking or are planning to take has a side effect that may be life-threatening, it is important to know what early symptoms of that effect are and to monitor for them.

    Learn to recognise, monitor and manage side effects should they arise. Often, simple solutions exist to lessen many side effects. In other cases, a particular side effect may be an important signal that requires immediate medical attention.

    Most importantly, reach out for support - from your family, friends or support group. If you can, let them know what’s going on. Sometimes just talking helps, but they might also have ideas to help ease side effects that your doctor might not mention.

    However, it is dangerous to simply stop taking one drug in your regimen, reduce the dose without talking with your doctor and pharmacist, or decide only to take it periodically. This can do more harm than good as it leads to drug resistance, making that drug - and perhaps others less useful for you now or in the future.

     

    Fatigue

    It’s not unusual to feel tired, especially when life is hectic. But a sense of tiredness that doesn’t go away with rest is a problem. If ignored, fatigue can worsen. Symptoms of fatigue can be physical (like it’s difficult to get out of bed or walk up stairs) or psychological (like having a hard time concentrating). Fatigue is also a symptom of another drug side effect - anaemia.

    Getting a handle on fatigue begins with acknowledging it. If you’re feeling fatigued, ask yourself: how long have you been tired? Are there activities that are difficult today that weren’t a problem a few months ago? Are you having trouble concentrating? Are you having trouble sleeping or sleeping more than normal?

    • Try going to sleep at night and waking in the morning at the same time every day. Changes in your sleep schedule can actually make you feel tired.

    • Try to get a little exercise. Exercise eases stress and makes you feel stronger and alive.

    • Keep easy-to-prepare foods on hand for times you’re too tired to cook.

     

    Anaemia

    Anaemia is low red blood cells. These are the cells that deliver oxygen to different parts of your body. When your body is short on oxygen, you feel fatigued. Most people with HIV have anaemia at some point. In some cases, stopping or changing the drugs that are causing anaemia may be necessary. Treating severe anaemia requires a blood transfusion.

    • Know your red blood cell (haemoglobin) count. Get it checked regularly.

    • Fish, meat, and poultry are high in iron and vitamin B-12, both of which may lower risk of anaemia.

    • Spinach, asparagus, dark leafy greens, and lima beans are high in folic acid, another nutrient that may lower risk of anaemia.

     

    Headache

    The most common cause of headaches is tension, something most people have at some point. Medications, including anti-HIV drugs, can also cause them. They can also be helped, and prevented, by reducing stress.

    • For on-the-spot headache relief: try resting in a quiet, dark room with your eyes closed; place cold washcloths over your eyes; massage the base of your skull with your thumbs and massage both temples gently; take hot baths.

    • To prevent headaches from recurring: try to anticipate when pain will strike. Avoid or limit foods known to trigger headaches, especially caffeine (from coffee, tea, soft drinks or some medications), chocolate, red wine, citrus fruit (if more than half a cup per day), food additives, nuts, onions, hard cheese and vinegar.

     

    Nausea and vomiting

    These two symptoms often occur together. Persistent vomiting can lead to serious medical problems, like dehydration, chemical imbalances and even tearing of the oesophagus (throat). Call your doctor if you vomit repeatedly throughout the day or if nausea or vomiting is persistent and/or interferes with your ability to take your medication.

    • The BRAT Diet (Bananas, Rice, Applesauce, and Toast) helps with nausea and diarrhoea.

    • Leave dry crackers by your bed. Before getting out of bed in the morning, eat a few and sit in bed for a few minutes. This can help reduce nausea.

    • Try some peppermint, chamomile or ginger tea - they can calm the stomach.

    • Sip cold carbonated drinks like ginger-ale, 7-Up or Sprite. They can help avoid nausea.

    • Avoid hot, spicy, strong-smelling and greasy foods.

    • If vomiting occurs, replenish fluids with broth, carbonated beverages, juice, Jell-O or popsicles.

    • Talk to your doctor about the benefits/risks of anti-nausea medications (such as Compazine, Marinol, Ativan, Tigan, Zofran and Phenergan).

     

    Diarrhoea

    Aside from being annoying, the biggest concern is that diarrhoea can cause dehydration. So the first course of action is to replenish lost liquids by drinking plenty of fluids, like Gatorade, ginger-ale, chicken or beef broth, herb tea or just plain water. Chronic diarrhoea may lead to weight loss.

    • Eat foods high in soluble fibre, which slows diarrhoea by absorbing liquid. In addition to the BRAT diet, these foods include oatmeal, cream of wheat, grits and soft bread (not whole grain).

    • Avoid foods high in insoluble fibre, like the skins of vegetables and fruits. These foods can make diarrhoea worse.

    • Try to avoid milk products and greasy, high-fibre, or very sweet foods. They tend to aggravate diarrhoea.

    • Try taking calcium supplements (500mg twice a day).

    • Prevent dehydration by drinking lots of fluids.

     

    Weight loss

    Weight loss can be a serious problem in HIV disease. It can result from some side effects like vomiting, nausea, dry mouth, anaemia or fatigue. If you’re losing weight and it’s not because you altered your diet or exercise patterns for that purpose, it’s never a good thing.

    • Monitor your weight. If you are losing weight, work with your doctor to determine the cause. Is it stress-related? Is it accompanying nausea or vomiting? Has it occurred after starting a new medication? What other things are going on?

    • Try high protein shake mixes, like Med-Rx or Metabol. Look for products high in protein and low in sugar. These are available at most health food and vitamin stores.

    • Ask about discounts at health food and vitamin stores. They sometimes provide people with life-threatening diseases special savings on nutritional products.

     

    Dry mouth

    Dry mouth can result from taking certain medications. It is an uncomfortable condition, making chewing, swallowing and talking difficult. Dry mouth can affect your sense of taste and can promote mouth problems, like tooth decay and oral yeast infections (thrush).

    • Drink plenty of liquids during or between meals.

    • Avoid sugary or sticky foods or caffeinated drinks since these can make your mouth even drier.

    • Rinse your mouth throughout the day with salted warm water.

    • Try slippery elm or licorice tea (available in health food stores) - they lubricate the mouth and taste great.

    • Suck on sugarless candies, lozenges or crushed ice to cool the mouth and give it moisture.

    • Ask your doctor to prescribe products or mouth rinses to treat your dry mouth.

     

    Rash

    Rash seems to be a slightly more common side effect among women taking certain anti-HIV medications than men, though it does occur in men as well. Nevirapine (Viramune) and nelfinavir (Viracept) appear to be the main culprits.

    • Keep medications like Benadryl on hand in case you develop a rash. It will soothe and comfort the skin.

    • Try using unscented, non-soap cleansers or oatmeal soaps.

    • Protect your rash from sun exposure as the ultraviolet (UV) rays of the sun may exacerbate a rash.

     

    Peripheral neuropathy

    Peripheral neuropathy is caused by damage to nerves. When these nerves are damaged, it can cause a sensation of burning, stinging, stiffness, tickling or numbness in the feet, toes or hands.

    • Wear loose-fitting shoes, roomy cotton socks, and padded slippers around the house. Good air circulation around the feet helps.

    • Keep feet uncovered in bed. Bedding that presses down on your toes can add to the problem.

    • Walk around, but not too much. Walking helps blood circulate in the feet (a good thing), but too much walking or standing can make the problem worse.

    • Soak feet in ice water to reduce foot pain.

    • Massage your feet. This reduces foot pain temporarily.

    • Try ibuprofen to reduce pain and swelling.

    • Use L-acetyl carnitine (available at health food stores or through prescription) to prevent the peripheral neuropathy related to DDI, D4T and/or hydroxyurea.

     

    Period problems

    Problems with periods can be a side effect of some medications. Most recently, excessive menstrual bleeding has been seen when using Ritonavir (Norvir). It’s a good idea to track your periods, noting changes if they occur, particularly around the time of beginning a new anti-HIV drug.

    • Consider what else is happening in your life. Have you lost weight? Are you stressed out? These factors might give you clues as to why you’re having period problems.

    • For menstrual cramps, hold a hot water bottle or a heating pad over your lower stomach or back. Or take a hot bath. This reduces stress, too.

    • Do mild exercise, like walking or stretching. Exercise may increase blood flow and decrease period pain.

    • Oral contraceptives (the Pill) are sometimes used to regulate abnormal periods. Some anti-HIV drugs interact with the Pill.

     

    Hair Loss

    Most people experience hair loss as they get older. This is normal and affects some people more than others, especially if baldness runs in the family. Hair loss can be disturbing nonetheless, and can damage one’s self-confidence.

    • To protect your hair from further damage and loss: avoid or decrease damaging hair care practices or use them infrequently. These include dyeing, perming, straightening, braiding, corn-rowing, using hair dryers, etc.

    • Don’t be fooled by fraudulent claims for products that promise to cure baldness. The only remedy that comes close is the medication Rogaine, available over-the-counter.

    • Stress can make hair loss worse, so taking steps to reduce stress and anxiety often help.

     

    - Courtesy Project Inform 2001

  • Did Nkosi have to die?

    South Africa’s Aids “celebrity” Nkosi Johnson raised the profile of his country’s neglected sufferers. Nkosi died a hero in the battle against Aids in Africa, but he was not a martyr. Martyrs are those who choose death in pursuit or in defence of their beliefs, but 12-year-old Nkosi did not choose death.

    Death chose him, even before he was born HIV-positive to a mother who died of Aids before his third birthday. Back then, his adoptive mother Gail Johnson was told Nkosi had nine months to live, but he went on to be South Africa’s longest surviving Aids orphan. But it was not only his longevity that made Nkosi unique among the estimated 800,000 Aids orphans in South Africa, whose number grows by 70,000 every year.

    Propelled into the media spotlight by the Aids activist community, Nkosi Johnson became the human face of a plague to which the South African authorities had responded sluggishly. The cute kid with the big, shiny eyes and warm, toothy smile shocked South Africa out of its denial as he travelled the country making public appearances, forcing his compatriots to acknowledge the humanity of Aids sufferers and to bring discussion of the disease out into the open.

    “It’s a great pity that this young man has departed,” former President Nelson Mandela told reporters after Nkosi died. Like the overwhelming majority of South Africans infected with HIV, Nkosi’s family was unable to afford the anti-retroviral drugs commonly used to treat the disease in the developed world.

    Like their South African counterparts most Kenyan Aids patients are so poor that their only hope of survival is free access to treatment drugs through the public health system. And Nkosi himself might have eluded his fate had his mother had access, during pregnancy, to AZT and other treatments known to prevent mother-to-child transmission of the virus.

    · Courtesy Time Inc. 2001

  • Enforce Bill, Govt urged
    By Marceline Nyambala

    Kenya Coalition for Access to Essential Medicines, is calling on gov-ernment to enforce the Industrial Property Bill 2001 to facilitate access to cheaper versions of antiretroviral (ARV) drugs.

    The Bill, passed in June is to enable thousands of Kenyans get affordable treatment with generic ARVs without necessarily flouting patent laws.

    The coalition says the minister for Trade Nicholas Biwott and Health ministry counterpart Professor Sam Ongeri did a splendid job pushing for the passage of the Bill in parliament.

    “We now need them to go an extra mile, and give notice of commencement of the legislation, “ said Sisule Fredrick Musungu an independent lawyer with the coalition.

    The World Trade Organisation (WTO) has stipulated the minimum duration for a patent to be in existent in a country to be 20 years with which Kenya is now compliant.

    The Bill spells out the procedure to be followed in acquiring generic drugs by the country. But Sophie Marie Scouflaire regional pharmacist, Medicines Sans Frontiers (MSF) emphasises that not everyone who is HIV positive needs to be on antiretroviral drugs.

    She said, “I want to say that the drugs should only be used at the later stages. Basically stage three, and four. They may extend the life of individuals by at least five years.

    Currently the prices are way out of this world. Almost impossible for those who need them which is why we need to make it possible to access the generics.

    “With the Bill in force, Scouflaire says the drugs could be accessed at only one third of the price. Currently, the cheapest triple therapy costs about Sh78,000 while a generic version would cost about Sh27,000.

    Some times the prices of the brand patented version is pushed up by things like packaging, and marketing. The big question which has been asked at many meetings has been if the price is justified!”

    Pharmaceutical companies argue that they need to be compensated for their efforts in research, and investment in general and give a period of 20 years to recover their costs. The major problem is that people are in the meantime dying.

    The coalition thus hails the recent Doha Qatar decision on Trade Related Aspects of Intellectual Property Rights (TRIPS). The unanimous decision that governments should take all the necessary steps to protect public health through the Doha declaration.

    ‘’This is a great victory that puts the responsibility squarely on the shoulders of the ministers for Trade and Health to bring down the cost of essential medicines and increase access to life saving treatments for the Kenyan people,’’ says Musungu.

    The coalition on access consists of organisations and individuals including Action Aid, The Association of people living with Aids in Kenya (TAPWAK), Health Action International (HAI Africa), Network for people living with HIV/Aids (NEPHAK), Women Fighting Aids in Kenya (WOFAK).

    Others are Society for Women and Aids in Kenya (SWAK), Nyumbani and International CARE, Medecins Sans Frontiers (MSF), DACASA, Kenya Medical Association, Consumer Information network and the Campaigners for Aids Free Society.

    “It’s a voluntary coalition. No one is paid for their time, and we’ve pooled together various experts,” says Malini Morzaria the information officer.

    “All my patients at the Mbagathi referral clinic have qualified for the antiretroviral drugs,” says Dr John Wasonga member of the coalition. “They are mainly at the third, and fourth stages of Aids.”

    Dr Wasonga runs three MSF clinics, at Mbagathi district hospital, Pumwani health centre and Dandora health centre. He says, “ At Mbagathi we run a free referral clinic three times a week for HIV/Aids patients. I sound like a mad man talking to them about the antiretrovirals and when they look at the prices because it doesn’t make sense.

    “Many say they cannot even afford the drugs I prescribe for them for the various opportunistic infections that they suffer. I see at least 150 patients a month. Only 10 of these can afford. Yet two of my patients who had full blown Aids, and were basically at the death bed have returned to work and are contributing to nation building.

    “The biggest side effects my patients report are the holes in their pockets. Many can’t afford as individuals and must be supported by their relatives and friends.

    “Pharmaceutical companies feel that cost is not the only hindering factor to access of ARVs. The coalition says that most public hospitals lack the capacity to administer ARVs as they require laboratories to facilitate pre-treatment procedures. Doctors too need to be retrained as not all are knowledgeable on the administration of ARVs.

     

  • Is Aids vaccine still a mirage?
    By Dann Okoth

    Although awaited with great anticipation, an Aids vaccine may not become available so soon. And, after the controversy over patent rights between Kenyan scientists and their British counterparts has been resolved, frenzied but protracted trials that could stretch far into this decade are finally on course. Kenyan researchers conducting human trials of an Aids vaccine in Nairobi predict that it will take another six or seven years before the first vaccine is licensed for use. This in essence means that prospective candidates for an HIV vaccine will have to wait until the year 2007 or 2008 to receive their jabs. The trials being conducted concurrently in Kenya and Britain have entered the second stage after what the researchers say were “successful” first stage results. According to Dr Omu Anzala, director of research at the Kenya Aids Vaccine Initiative (Kavi), the first stage trials with necked DNA vaccine and involving some 18 Kenyan volunteers have gone “very well”.

    He says the 18 Kenyan volunteers obtained mainly from Nairobi in order to facilitate easier “surveillance” had to be followed up over a period of 18 months after the administration of the trial vaccine to determine its effects. In the first stage of the trials which began in February, the researchers tested the safety of the DNA construct as well as determined its immunogenicity, that is, whether it provoked the required immunological response.

    The second stage trials, which have already begun, are aimed at confirming that one of the components of the trial vaccine is safe for use in humans. This component is known as the Modified Vaccine Ankara (MVA). This component has been used before to manufacture a vaccine for smallpox. The researchers intend to find out how the MVA reacts when it is modified for use with an Aids virus DNA fabricate to make an HIV vaccine. Ideally, both components of the trial vaccine are supposed to be used simultaneously, but have to be tested separately for safety purposes.

    Dr Anzala says that a vaccine has to go through four stringent trial phases before it is given a clean bill of health and recommended for use in humans. Perhaps this explains why millions of Kenyans stalked by the deadly scourge will have to wait much longer before they can finally acquire a defence against the killer disease.

    Dr Anzala says the first phase involves testing the trial vaccine for safety i.e. if the vaccine can be safely administered to humans. The second phase, Dr Anzala explains, involves finding out if the trial vaccine is immunogenic, that is to say, whether it provokes the right kind of immunological response. This phase also determines the dosage and schedule of administering the vaccine.

    The third phase of the trials aims at confirming the efficacy of the trial vaccine to determine whether the vaccine has any level of protection. The final phase seeks to determine the effectiveness of the vaccine. At this stage, Dr Anzala says, researchers have to determine if the vaccine can be produced in large amounts, distributed and administered. “Sometimes the production, storage, distribution and administration of a particular vaccine can be very expensive, that is why researches have to put into account the logistics at this stage,” he says. The vaccine was developed after studies conducted by Kenyan and British scientists on commercial sex workers at the sprawling Majengo slums in Nairobi in 1985.

    The women were discovered to have developed resistance and immunity to a certain type of HIV virus that infects Kenyans. At least three million Kenyans are infected with the HIV virus. Interestingly, four of the Majengo commercial sex workers have since tested positive for HIV. Kavi officials said the four women contracted the virus after they stopped practising prostitution.

     

  • Bruising intellectual property rights wars
    By Othello Gruduah

    International drugs companies were thoroughly bruised in South Africa early this year in a battle over importation of generic versions of high-priced antiretrovirals for the treatment of HIV/Aids. The war later moved to Kenya, but the multinational pharmaceutical cartel quickly backed off, albeit, grudgingly fearing a snowball effect across the rest of the world’s poorest continent.

    The fierce resistance from the drugs companies once again unlined the lingering question of whether the disease is naturally occurring or a deliberately orchestrated multi-billion dollar industry that mainly strikes at the weakest point of humanity.

    In a highly publicised case in April this year, the pharmaceutical companies abandoned a court action against the South African government after it legislated the importation of generic versions of expensive patented drugs against Aids. The drugs companies bowed out after a storm of protest from Aids activists, who considered their action as “inhuman and driven by greed.”

    South Africa, which analysts say has the largest number of people living with HIV or Aids - 4.5 million - took the decision following an announcement by Indian company, Cipla Ltd, in February that it was prepared to export generic Aids drugs at significantly reduced costs.

    Press reports quote the Bombay-based company as offering to export Aids drugs for less than US$1 a day. Kenya, with an estimated 2.2 million HIV-positive population, followed suit in June when its parliament unanimously approved the so-called Industrial Properties (IP) Bill 2001, eliciting instant reaction from the drugs giants. In effect, the Bill loosened the companies’ stranglehold on patent rights for a wide range of drugs, including antiretroviral Aids drugs.

    This time there was no court action, only verbal attack. “From our perspective, nothing will change at all,” says Harvey Bale, director-general of the Geneva-based International Federation of Pharmaceutical Manufacturers’ Associations. In contrast, Aids activists welcomed the Parliament’s move, saying it would allow more of Kenya’s 2.2 million HIV-positive sufferers access to drugs which have helped reduce deaths resulting from the scourge in the West by three quarters.

    Bale, however, countered by saying that some 80 per cent of the drugs currently in use in Kenya to fight Aids, including antiretrovirals, were unpatented and that the remaining medicines were being sold by the drug companies locally at the same price as copied versions.

    “This is a political event that will not make any difference to the health care being received by the Kenyans.” Bale further argued that only significant international funding will help Kenya tackle Aids. He believes the country’s health budget was too limited to cope with the costs of any drug programme.

    “Even at a dollar a day (for Aids treatment), this would be 10 times the total current per capita spending on health in Kenya,” he added.

    Earlier, in an attempt to preempt the parliamentary vote, world’s top supplier of HIV/Aids drugs, GlaxoSmithKline Plc, announced it was further slashing the price of its antiretroviral drug cocktails in the country. “We are going to make our products cheaper,” Glaxo (Kenya) sales and marking director, William Kiarie, told reporters.

    But the move was met with scepticism by Aids campaigners, who said it was intended to emasculate the Bill. Sophie-Marie Scouflaire, regional pharmacist for the medical aid charity, Medecins Sans Frontieres, responded:

    “They have to say when they will reduce the price and for whom. I want to see the drugs available in the pharmacies.”

    Analysts say the cost of triple combination therapy, which has helped reduce Aids deaths in developed countries by 75 per cent, has been well beyond the scope of most Kenyans and only 1,000 of the country’s 2.2 million Aids victims can afford it. The antiretroviral therapy prevents the deadly virus from replicating, thereby easing the disease’s symptoms while prolonging lives.

    In July, Africa’s most populous nation, Nigeria, announced it would begin treating 15,000 of its nearly 3 million HIV-positive patients with sophisticated virus-fighting drugs.

    The announcement came via UN Secretary General Kofi Annan’s special Aids envoy to Africa, Stephen Lewis. “It is the government’s intention on September 1, to begin a process of antiretroviral treatment in Nigeria, which will be, at least initially, larger than anywhere else on the continent,” he told journalists.

    President Olusegun Obasanjo is said to have procured the drugs at a cut-rate US$350 per person per year by sending Nigerian health officials to India to negotiate directly with Bombay-based Cipla Ltd. The government was to start out offering a six-pill-a-day regimen to 60 per cent of patients and two pills a day to the remaining 40 per cent, to test the effectiveness of the various cocktails. It was to subsidise up to 80 per cent of the cost, leaving patients with a monthly bill of about US$7 to US$8.

    The UN estimates that the pandemic has claimed 22 million victims world-wide and left a further 36 million facing a death sentence. Out of the 36 million people infected with the HIV virus, or already suffering from full-blown Aids, 25 million are in Africa.

    But while the drugs industry may have lost the battle in one aspect, in another, they are smiling: the fact that no serious efforts are being made to have independent scientists research into finding cure for the scourge. The independent-minded scientists have been referred to by the powerful pharmaceutical companies and governments that back them as “dissident or rogue scientists.”

    The scientists are being given the tag simply because after extensive research, with credible evidence, they strongly believe the disease is a laboratory, manufactured product by the pharmaceutical giants, who have patented it under government sponsorship.

    The plausibility of such claims is based on the fact that the world accepted, without question, the dogmatic biochemical name coined for the disease: Acquired Immunno-Deficiency Syndrome (AIDS)/Human Immuno-deficiency Virus (HIV), hitherto unknown to any traditional society. Medically, the HIV virus which causes Aids has never been isolated. In fact, it is claimed that no Aids research can take place without consultation with and guidance of the pharmaceutical giants, through which funding is channelled. As long as this state of affairs obtains, there can be no real war against the most lethal mass murder machine in human history, only production of drugs for prolonging life.

    Dissident scientists say the HIV, as it has come to be known, has had three official name changes during “Special Virus” development. These are:

    1. ‘Leukaemia and tumour viruses of Animal and Man’

    2. ‘Cancer Virology’

    3. ‘HIV/AIDS’

    The problem now is that the disease has ravaged the world so much, particularly Africa, affected every sphere of life, that admitting to its development would be suicidal on the part of any government.

    It must be noted, though, that the United States federal government reached an agreement with the World Health Organisation (WHO) to destroy the cholera virus in its biological warfare arsenal at the end of 1999. But come 1999, the US refused to honour the agreement, saying it needed the virus for future research. Because of the US decision, Russia also declined to destroy its own cholera virus.

     

  • City hospital managing the scourge with antiretrovirals

    The recent reduction in prices of anti-retrovirals could help change the face of HIV/Aids in Kenya. Dann Okoth looks at what Nairobi’s Mater Hospital is doing.

     

    Sharp reductions in prices of antiretrovirals announced by two lead-ing pharmaceutical companies, and frenzied efforts by a city hospital to provide affordable treatment to HIV/Aids patients is revolutionising the management of the pandemic in Kenya.

    It is hoped that a further reduction in prices of the anti-retroviral drugs by several other multinational pharmaceutical companies will ensure the runaway scourge is effectively reined in.

    The Phillips Pharmaceutical Limited, distributors for Bristol Myers Squibb and Merck Sharp Dohme (MSD), have announced price reductions on HIV/Aids drugs of between 80 and 97 per cent.

    The two companies have subsequently appointed Mater Hospital in Nairobi to dispense their products under the emblem of Increased Access Initiative Programme. Under the programme both drug companies seek to accelerate the availability of life-saving medicines in the developing countries where the HIV/Aids pandemic has had widespread, and devastating effects on people’s lives.

    The ravages of the scourge has also placed a heavy burden on healthcare systems throughout a continent already under severe resource constraints.

    The companies argue that at these new prices, they will not profit from the sale of the drugs owing to the huge drop from the previous prices.

    These developments come in the wake of fervent campaigns by world leaders to force multinational pharmaceutical companies to reduce the prices of antiretroviral drugs to save lives in Third World countries.

    Mater Hospital, which is one of the few healthcare institutions that have been appointed HIV/Aids treatment centres in Nairobi, is recording huge numbers of patients who voluntarily test for HIV/Aids before starting on a treatment course.

    Initially, Mater received between 40 and 60 Aids patients a month, but this number shot up following the announcement of reduction in prices of antiretroviral drugs. The hospital’s health services marketing manager, Mrs Sunita Nathoo, says majority of Aids patients who seek treatment at the hospital fall within the 25-45 years age bracket.

    She says the increase in the number of patients at the hospital has been spurred by the reduced treatment costs. Mater is effectively using cheap triple combination therapy of original antiretroviral drugs. Some of the triple combinations include that of Stocrin (20mg), Zerit (40g) and Videx (100mg) which goes for Sh5,597, Stocrin and Combivir which costs Sh9,163 and Stocrin, Retrovir and Videx which goes for Sh9,831. All these are one-month combination dosages.

    While doctors prefer the triple dosages because of their effectiveness in combating the virus, the new prices have meant that the drugs which were before unaffordable for the majority of patients are now more accessible. A single dose of Stocrin, for example, used to cost Sh17,745 per packet of 90 tablets. A single packet of Zerit containing 60 tablets used to go for Sh13,650 while a packet of Crixian containing 180 tablets would cost Sh24,840.

    Nathoo says that the triple combination therapy has had great success in patients whose conditions were diagnosed early enough. She stresses the need for early diagnosis to aid cheaper, more effective management. “We sometimes receive patients whose conditions have deteriorated so much so that they are brought here in a coma,” Nathoo said adding, “this often means more time in hospital, and much higher medical expenses.

    “Nevertheless, Mater does not turn away patients who arrive at the hospital to seek treatment. This is because most of our patients are covered and always get to pay at the end of the day.”

    But not everybody would afford. Even with the hugely reduced prices some patients still find the costs particularly high. Which is why, says Nathoo, government should move in to subsidise treatment costs in all health institutions to enable more and more HIV/Aids patients get affordable treatment.

    She noted, “After declaring the scourge a national disaster the government should be seen to be committed to eradicating the disease. Of course everybody would like to help, but our sympathy and desire to assist is impeded by limited resources.”

    However, opponents of antiretrovirals argue that the toxic nature of the drugs far outweighs their perceived medical benefits. And, Nathoo, in an interview with The Big Issue last week confirmed this assertion. She said the side effects of the drugs could be severe but assured that with proper care they can be alleviated.

    According to Nathoo patients with advanced HIV/Aids status are put on nutritional supplements by doctors since their immunity and vital body organs may have virtually collapsed.

    PS:

The above report is brought to you by the courtesy of Gesundheit und Migration  (GuM Projekt beider Basel), Mediator Joseph Ogello Okullo, Sub-Sahara Migrants (HIV/AIDS Prevention. e-mail: info@jowopaonline.ch