top of page

The changing HIV treatment landscape and what it means for Africa:


The advent of combination anti-retroviral therapy in the late 1980s and early 1990s truly changed the scenery of HIV treatment and people living with HIV could have a better quality of life. Africa bears a disproportionate burden of HIV infection accounting for 70% of the total 36.7 million global infections of which only 21 million are receiving treatment globally. Combination therapy meant a mix of complex drug compounds and across Africa, high treatment cost, poor adherence and compliance to treatment often leads to treatment failure resulting from emergence of antimicrobial drug resistance. One highly prevalent disease across Sub-Saharan Africa is hepatitis B virus and is the leading cause of liver cancer and hepatocellular carcinoma. The problem across Africa is that Hepatitis B is not systematically screened in HIV patients before treatment initiation.

What’s going on in the HIV treatment world?

The current recommendation of national and international treatment regulators for treating HIV involves use of drugs such as lamivudine and tenofovir as backbone treatment that provide prophylactic cover against Hepatitis B since both viruses use the same RNA replicative machinery for replication. Poor adherence, high cost of treatment and associated co-morbidities such as renal and liver insufficiency that results from HIV treatment has led to global interests in simplifying treatment to regimens that may not include these drugs that provide prophylactic cover against Hepatitis B virus. On of these new and very interesting treatment option is the use of two HIV drugs: cabotegravir and rilpivirine. This particular drug combination can be given as injection once every month or two months and are highly potent and efficacious against HIV but have no effect on Hepatitis B virus. This is a game changer that can improve adherence, reduce cost, and prevent co-morbidities associated with combination therapy especially in Africa however, it may have devastating long term consequences. This is because co-infection of HIV with hepatitis B accelerates the progression of liver disease and has become an important predisposition when considering treating HIV patients.

What’s the Key message?

It is important that regions where Hepatitis B virus is endemic such as Africa adopt treatment regulations that are in the interest of people living in these regions. Ideally, in the absence of contra-indications, the treatment regimens should provide prophylactic cover against both HIV and Hepatitis B virus. In the event national policy makers choose to adopt simplified treatments, routine Hepatitis B tests should be performed to ascertain infection and prevent hepatitis B virus which can prevent overall quality of life in HIV patients.

Happy to answer any questions if I can :)

bottom of page