November 30, 2023

Voices from Zambia: Improving HIV Treatment with DRV/r

DRV/r is more effective and less toxic than other second-line HIV treatments, but for many years was too expensive for lower-income countries to use. Now that an affordable generic version of DRV/r is available and in use, we wanted to hear from those taking the medication.

A lot has changed in the time since CHAI and Unitaid announced a landmark pricing agreement with Hetero Labs for best-in-class HIV treatment darunavir/ritonavir (DRV/r), and rollout began in Zambia and Nigeria;

  • The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has placed orders to buy Hetero’s DRV/r (400/50 mg);
  • The World Health Organization (WHO) has committed to reviewing its      second-line HIV treatment guidelines (in response to ongoing advocacy by Afrocab), which could result in recommendations prioritizing DRV/r as the preferred treatment after dolutegravir (DTG); and
  • Zambia and Nigeria are scaling DRV/r nationally to ensure all people can access this best-in-class medicine if needed.

CHAI recently joined the Zambia Ministry of Health to visit health facilities in Southern Province and Central Province to check in on how the transition to DRV/r was going. During one of these visits, we sat down with two people who are living with HIV and recently transitioned to DRV/r. Their interviews have been edited lightly for clarity.

Health workers holding bottles of DRV/r

Interview with male from Central Province

HIV treatment history: 17 years

Regimen history: Nevirapine → Lopinavir/ritonavir (LPV/r) → Atazanavir/ritonavir (ATV/r) → DRV/r (12 months)

How would you say the difference is between the previous drugs you took and DRV/r?

For me, I’ve never experienced side effects with the drug [DRV/r]. So far, I would say this is the best drug for me.

But with the previous ones there were some side effects that you noticed?

Yes, especially Aluvia (LPV/r) cause Aluvia used to give me those, what do you call them, more like tumors.

Like a skin reaction?

Yes exactly.

The pill burden too. Two in the morning and two in the evening. And they suspected Aluvia was causing the post-nasal drip. So I was switched from Aluvia in 2020 to ATV/r. So now this ATV/r came with other side effects. Used to tarnish my eyes, yellowish, and the nails. Until last year when I was put on DRV/r.

How long did it take you to notice, from the time you initiated DRV/r, that you have no side effects?

The first time I was put on HIV treatment I was advised to stay on that drug for two weeks to see if there were side effects. So now for this one [DRV/r], in the first two weeks I expected to experience those side effects but none came up. So far so good.

What advice do you have for clients who may be hesitant to switch to a new drug like DRV/r?

For me I’d want to encourage these other clients to adhere to these drugs. For me it’s the best. I’ve never experienced anything bad ever since I started taking this drug. That was last year in August 2022, meaning it’s been a year. So it’s just positive encouragement to any other client.

Interview with female from Southern Province

HIV treatment history: 14 years

Regimen history: LPV/r → Dolutegravir (DTG) → ATV/r → DRV/r (4-5 months)

What challenges did you face with your previous treatment?

I was given drugs [LPV/r] for two weeks which gave me diarrhea. I went back to the hospital but I was told to take them for one more month and see what happened, that probably the body was trying to adjust to the new treatment—but nothing changed.

So, I went back to the hospital, and I was switched to a different drug with pink tablets [DTG]. With this one I used to vomit, sometimes even three times a day, throughout the period I took it. I went back to the hospital and that is how they switched me to ATV/r.

On ATV/r I used to feel very strange. I would experience bloating of my stomach and sometimes muscle cramps. I just used to feel so weird on ATV/r and my body wasn’t as free as it is now that I am taking DRV/r.

How has your experience been taking DRV/r?

So far so good, I do not have any complaints, no side effects and my body feels so free.

How long did it take you to notice any changes?

It took about three weeks, I never paid much attention at the time I started taking DRV/r, but I just noticed that my body was feeling way different and a lot better. That is how I realized that ATV/r was not very good for me.

Do you prefer DRV/r or do you prefer your previous medication?

No, I would not want to go back to the ATV/r. I am very much okay on this new drug so much so that changing me to a different drug will require a lot of conviction with justifiable reasons. Please ensure that the drug is always available so that I am not forced to switch back to the drug that has not worked well for me.

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