Sub-Saharan Africa in the scope of an increased burden of antiretroviral therapy related adverse effects

A paper published today in Infectious Diseases of Poverty discusses the challenges of the “test and treat” policy implementation in sub-Saharan African (SSA) countries, with a special look at antiretroviral therapy (ART) related adverse effects. Here one of the authors, Jobert Richie N. Nansseu, tells us more.

The paper figures out the dire lack of preparedness and readiness of sub-Saharan African (SSA) countries to cope with the consequential up-coming increased burden of ART-related toxic and metabolic complications, and highlights the urgent need to fill the lacunae if SSA is not to become over-burdened by the consequences of the “test and treat” policy in the near future.

Chronic exposure to ART leads to serious medication-related adverse effects.

The positive change in the natural history of HIV/AIDS following the introduction and widespread use of continuous ART is no longer a topic of debate. Further, it has been clearly demonstrated that early ART initiation results in significant HIV transmission reduction, which is the rationale supporting the “test and treat” policy of the World Health Organization (WHO). As SSA is the epicenter of the HIV pandemic, it is believed that this region will benefit the most from this policy.

However, chronic exposure to ART leads to serious medication-related adverse effects. Therefore, it is anticipated that implementation of the WHO policy will lead to an exponential increase in ART-related adverse effects incidence and prevalence, especially in SSA where these conditions (such as cardiovascular disease, lipodystrophy, prediabetes and overt diabetes, insulin resistance and hyperlactatemia/lactic acidosis) are already getting to epidemic and alarming proportions.

In this context, SSA could be over-burdened subsequently to the “test and treat” implementation in the region. To know whether the region is yet ready and adequately prepared to cope with these challenges requires an up-to-date interrogation warranting an urgent examination so much so that the gaps could be rapidly identified and filled accordingly.

Most SSA countries are characterized by (extreme) poverty, very weak health systems, inadequate and low quality of health services, inaccessibility to existing health facilities, lack of (qualified) health personnel, lack of adequate equipment, inaccessibility and unaffordability of medicines, and heavy workload in a current context of cohabitation of infectious and non-communicable diseases.

Furthermore, there is dearth of data on the incidence and predictive factors of ART-related adverse effects in SSA, to anticipate on strategies that should be put in place to prevent the occurrence of these conditions or properly estimate the upcoming burden and prepare an adequate response plan.

SSA Governments, researchers and financial partners all together should come into play to work at identifying all the challenges related to the “test and treat’ policy implementation in the region and quickly address each of them so that implementation of such a policy does not aggravate the current burden of disease in SSA.

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