Kampala lab to monitor HIV drug resistance

In 1991, Naomi Mbabazi was an upper senior secondary student when the blood donating van called at her school in western Uganda.

She and her peers casually decided to donate blood. What began as a gesture to save other people’s lives became a horrendous revelation for the teenager when she discovered she was HIV positive.

“I was shocked. I was still young. But I continued to lead a normal life keeping the results to myself until 2002 when I fell sick,” says Ms Mbabazi, a 36-year old mother of two healthy HIV negative children.

Ms Mbabazi suffered from most of the HIV related opportunistic infections like candidiasis and pulmonary tuberculosis and was admitted in hospital for a long time.

Luckily, she got a slot at the Uganda Joint Clinical Research Institute clinical trial “Development of ART in Africa” (DART 2003-2008).

Her participation enabled her to access free anti-retroviral therapy in October 2003.

Ms Mbabazi’s CD4 count at the beginning was 47 and she was started on first-line highly active antiretroviral therapy drugs — Combivir, Tenofivir and Septrin.

“I was so sick and desperate. When I learnt about a study with free ARVs, I instantly signed up,” says a smiling Ms Mbabazi.

At the time, the drugs cost $150 per month. But in 2009, she had a relapse in spite of the drugs. She discovered she had lipodostrophy — unequal distribution of fats on the body — which is also a sign of drug resistance.

“Colleagues told me, ‘Don’t you see that you are dying.’ I had a buffalo hump, small legs, a very big tummy; I was not born like that,” she recalls.

Medical experts say for the drugs to work properly, adherence to ART is crucial. That is, patients need to take all the pills and stick to a consistent schedule.

But this is not happening as patients tend to veer off the schedule over the long period of taking the drugs.

Coupled with the ease with which the virus can be transmitted, it is a nightmare keeping drug resistance at bay.

“We have put in place measures to ensure adherence is good but you cannot be 100 per cent certain on this. The ART drug resistance problem is in evolution and we need to be prepared to handle it,” said Dr Ivan Mambule Kiggundu at the Infectious Disease Institute (IDI) in Mulago.

In Uganda, there are over 200,000 people on ART, but according to a 2008 study by the Uganda Aids Commission, 71 per cent of the facilities surveyed retained less than 70 per cent of the patients on first line therapy over the first 12 months in spite of increasing accredited sites and drug availability.