Page 126 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 2 Editorial

Antiretroviral therapy optimisation in the

time of COVID-19: Is it really different in

North and South Africa?

Dear editors, we are attentively pursuing calls for an urgent need to have global and national
Authors:
Ahmed Cordie 1 actions to adopt differentiated service delivery (DSD) to ensure continuity of human
Menna-t-allah El-Kotamy 2 immunodeficiency virus (HIV) services, especially uninterrupted antiretroviral therapy (ART)
1
Gamal Esmat supply, during the COVID-19 (Coronavirus Disease 2019) pandemic. Location modification,
1
longer refill times and tailored packages of clinical services, including ART optimisation, are the
Affiliations:
1 Endemic Medicine main pillars of the transition toward DSD. 2
Department, Cairo University
Hospitals, Cairo, Egypt However, these interventions alone are not sufficient in low- to middle-income countries (LMICs),
where the lockdown and restrictions applied to international movement may affect ART supply,
2 Egyptian Patent Office,
Academy of Scientific especially for imported medications. Medicine stock-outs are an unfortunate possibility for
Research and Technology, treatment discontinuation and the emergence of drug resistance. 3
Cairo, Egypt
Following the World Health Organization (WHO) recommendations, the Egyptian guidelines set
Corresponding author:
Ahmed Cordie, the combination of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) plus dolutegravir
[email protected] (DTG) as the preferred first-line treatment regimen for adults and TDF/FTC/efavirenz (EFV) as
an alternative first-line regimen. 4,5
How to cite this article:
Cordie A, El-Kotamy M,
Esmat G. Antiretroviral Egypt is reported to have very low HIV prevalence; however, it has the fastest increasing epidemic
6,7
therapy optimisation in the in the Middle East and North African regions. The Medicines Policy and Standards (PSM)
time of COVID-19: Is it really system can guarantee uninterrupted ART supply when the framework cycle is properly
different in North and South functioning at all levels of the healthcare system. Unfortunately, LMICs usually have
Africa? S Afr J HIV Med. 3
2020;21(1), a1118. https:// underdeveloped PSMs, and hence face the risk of stock-outs.
doi.org/ 10.4102/sajhivmed.
v21i1.1118 During the COVID-19 crisis, the situation is expected to be more complicated; therefore, resilience
is needed to enable the health system to follow the WHO treatment recommendation guidelines
Copyright: 4
© 2020. The Authors. and keep treatment for all as a first priority, at the same time as the context is rapidly evolving.
Licensee: AOSIS. This work Therefore, ART included in national treatment regimens may need to be locally manufactured for
is licensed under the the time being.
Creative Commons
Attribution License.
Our search revealed that FTC and EFV are not patented in Egypt, and the only patent on
lamivudine (3TC) has expired. Tenofovir disoproxil fumarate, 3TC and EFV are all locally
manufactured and available at an affordable price. Dolutegravir (a ViiV product), provided under
voluntary license in South Africa, is part of a patent filed in Egypt that was technically rejected
and is still under appeal; however, it is also provided under voluntary license. Gilead Sciences
have patents on TDF/FTC in a number of countries, but not in Egypt or South Africa. 8

Neither DTG nor the TDF/FTC 2-in-1 combination is locally manufactured in Egypt. In these
critical times, local pharmaceutical companies should be encouraged to produce these medicines
to avoid dependence on the originators, who do not even have patent rights in Egypt.

Currently, Egypt and many LMICs are in an extraordinary situation. These desperate times
demand extraordinary measures. With respect to the WHO first-line ART recommendation for
adults during the COVID-19 crisis, to ensure stable ART supply, we recommend the following:
• Antiretroviral therapy–naïve patients should start locally produced TDF + 3TC + EFV, as
Read online: this stock may be less threatened than the TDF/FTC 2-in-1 combination and DTG-based
Read online:
Scan this QR
Scan this QR regimens.
code with your
code with your
smart phone or • In contradiction to what is recommended in South Africa and many sub-Saharan countries,
smart phone or
mobile device we recommend slowing down the transition from EFV to DTG to save it for those already
mobile device
to read online.
to read online.
using it.
http://www.sajhivmed.org.za 118 Open Access