195 Zimbabweans On Third Line ART Drugs

THERE are about 195 patients on the third line Antiretroviral Treatment (ART) regimen in Zimbabwe which health experts say is not a good sign.

By Kuda Pembere

While presenting at the Zima Scientific Conference, Newlands Clinic’s Chimbetete said due to lack of genotype resistance testing in the country’s public health institutions, they could not get some of the results like Viral load and CD4 counts. This was from a study they did on the four centres with people on third line ART namely Newlands Clinic, Mpilo Hospital, Harare Central Hospital and Parirenyatwa Group of Hospitals.

“So as of December 2018, there were 21 patients receiving ART at Parirenyatwa Hospital  with a median age of about 49 years of age. Their median duration on third line was about 1, 3. These patients had had a median time on first line ART of 3, 3 and a median time of 3,1 years on second line art.

“Remember that ART is supposed to be for life. And life may mean 10, 15, 20, 30 years. So somebody is failing first line after three years and failing second line after three years, your guess is as good as mine on how long they will take to fail second line. Unfortunately we did not have access to their viral load and CD4 counts because of unavailability because only one patient had documented HIV drug resistance,” he said.

He said at Harare Central Hospital had the least number of patients on third line.

“From Harare Hospital, there were 15 patients accessing third line with a median age of 38,time on third line was one year, duration of first and second lines was 3, 5 and 4, 4 years. This is not acceptable.

“What it means is that the patients’ problems, the problems they had with first line were just carried over to second line and carried over to third line. The problems were not addressed. We did not have baseline viral load and CD4 and no patient had documented HIV drug resistance.

“What this means is that anybody with high viral load on second line was diagnosed second line failure yet I told you initially that more than 50 percent of those patients actually would not have failed second line,” said Dr Chimbetete.

Dr Chimbetete on Mpilo said the Bulawayo Hospital had 35 patients with a median age of 44.

“Time on third line 2, 3 years. Time on first line 5, 2, on the second line 2, 3 years. No complete data on their clinical parameters,” he said.

Newlands Clinic had the highest number.

“I am going to share a bit more on the Newlands Cohort which is the biggest cohort in terms of third line art in the country. As of December 2018, we had a 124 patients on third line art with a median age of 42. median duration on third line was 1, 4. Median duration on first line was 4, 5 years and 3,3 years on second line. 89 which is 72 percent of these patients had documented drug resistance results. The reason why some of them didn’t have was at one time we had stockouts in the national program and we received a lot of transfer-ins from the other third line centres. Therefore we had no access to their resistance tests,” he said.

Dr Chimbetete told this publication that the number is not encouraging as the costs may be too heavy to bear for the patients.

Many more may need 3rd line but failing to access it and have no money for the required tests,” he said.

He said getting a genotype resistance test means one has to cough up US$600 of which some of the tests are sent to South Africa.

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