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Do or die

Do or die

Profs Francois Venter and Ian Sanne

HIV/AIDS and TB might still be the biggest cause of death in SA, but huge strides have been made in decreasing the mortality rate.

At the recent Wits Faculty of Health Sciences 14th prestigious research lecture entitled “ART: Do or die” attendees were privileged to hear both Prof Ian Sanne and Prof Francois Venter talk on HIV/AIDS with a specific focus on South Africa and Wits.

Snapshot of HIV in SA (November 2016)

  • 6-7 million people HIV positive – 18% of world total, 25% of Southern Africa.
  • 6 million of those people are on first line antiretrovirals (ART) – Consume 25% of global generic ART.
  • 160 000 children on ART – prevention of mother-to-child transmission (PMTCT) working well (number of children born with HIV has dropped by 90%).
  • 150 000 patients on second line therapy, 800 on third-line therapy.
  • ART is going to cost SA over R6 billion per year by 2018 – HIV is the most financed disease in the world (includes research).

At the country-level, the HIV response is already having a dramatic impact on life expectancy. “What’s amazing is people with HIV are now living longer than those without HIV,” said Prof Venter. “The hope is that HIV will become an old person’s disease.”

  LIFE EXPECTANCY
CD4 Baseline 1 year ART 5 years ART
<200 71   & VL>50 54
200-349 78 78  
>350 77 81 & VL>50 80
General population 78    

CONCLUSION: If diagnosed, in care and on effective ART then life expectancy is normal.

“This is great information to give to people newly diagnosed and encourage good adherence,” Prof Venter continued. “The fact of the matter is we’re dealing with an old person’s disease. This is what it’s evolving into.”

While HIV/AIDS and TB might still be the biggest cause of death in SA, huge strides have been made in decreasing the mortality rate. “The second national burden of disease study for SA clearly shows that compared to cancer, diabetes, cardiovascular disease, and infectious and parasitic disease, we’ve got a handle on HIV/AIDS and TB.” It’s the only disease where the number of fatalities is decreasing every year.

But what about treatment?

According to UNAIDS 2016 estimates, proportionately, SA consumes by far the highest number of ARV in the world.

“More HIV drugs have been developed over the last 20 year than all other infectious diseases combined,” said Prof Venter. “The problem is things move very very slowly, while HIV moves very very quickly. We need things to go faster. Drugs take forever to go through the various approvals, licenses, and testing.

“An example is one of the drugs we’re using in first line treatment at the moment, a very good drug – Tenofovir** – it took 10 years after the FDA (Food and Drug Administration) registering it to it actually appearing in the programme, 11 years before it was available as a fixed dose combination.”

WITS – from clinical research to policy

“So why did we title this lecture ART: Do or die?” Prof Ian Sanne asked. “I think it is to embrace the imperative that we have all felt to address an epidemic, which when Prof Venter and I were registrars, was just emerging – in an era where the apartheid government and the post 1994 government were actually ignoring a response to HIV.

“So we felt a deep imperative, particularly as we saw antiretroviral therapy emerge. It was at a time when the medicine department and Wits felt that this was a dead end road. But we had this imperative to treat patients because we saw very early that in fact patients who had been treated in clinics where no one actually had ART and were dying. We suddenly had ART and people lived.

“We realised we needed to be activists, researchers, and clinicians. It is this integration of pre-clinical research work with our laboratory colleagues, integration into clinical research, and then integration into implementation sciences to epidemiology and health economics. That almost makes a mini university out of Clinical HIV Research Unit (CHRU) with our collaborators both domestic and international. Our funding stream is substantive, from many sources, often more than we can deal with and the team that has walked the path with me has grown, both in scientists as well as support staff, data mangers, nurses, and pharmacists who are critical to this process.

“Between Wits Reproductive Health and HIV Institute (Wits RHI) clinicians and Health Economics and Epidemiology Research Office (HE²RO), we form a clinical trials unit (CTU),” said Proff Sanne. “Between those two units we can reference over 400 publications as background information for our clinical trials unit application.

“We form part of the AIDS Clinical Trials Group (ACTG) network.” There are 191 sites internationally. “There are 5 sites in SA and Wits has the highest performing site in scientific contribution as well as participant enrolment for the last eight years. We compete for research effort with many of the sites in the US, with Harvard, Yale, and others. And do so successfully.

Right to care – Treating health seriously

“In 2001 we started a non-profit group called Right to Care,” said Prof Sanne. Right to Care is at the frontline in supporting and delivering prevention, care, and treatment services for HIV and associated diseases.

The section 21 company’s mission is to respond to public health needs by supporting and delivering innovative, quality healthcare solutions, based on the latest medical research and established best practices, for the prevention, treatment, and management of infectious and chronic diseases.

Right to Care embraces a strong entrepreneurial culture and is focused on innovation and the use of technology to enhance services, address skills shortages, and deliver quality healthcare outcomes. “Our areas of expertise include HIV, TB care and treatment, pharmacy automation, medical male circumcision, and cervical cancer diagnosis and treatment.

“Our vision is that every individual will have ready and affordable access to quality evidence-based medical services.”

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