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Durban project gives hope to AIDS patients
by Liz Clarke. - The Mercury, 26 Sept 2002. Republished courtesy of Independent Newspapers (Pty) Ltd
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Prince Cyril Zulu's Chest Clinic in Durban's Warwick Avenue is offering combined TB and AIDS treatment for the first time.
They looked like a handful of children's beads cupped into the palm of his hands - 14 in all, of different shapes, sizes and colours. If there was an aversion to taking them all at one time, it didn't show on Patient Number 10's face. Within two minutes, they were swallowed. Tomorrow, "Mr Ten", as he is known to doctors and staff at the Prince Cyril Zulu Chest Clinic in Durban's Warwick Avenue, will come back for another 14 pills, and he will return daily.
Like millions of South Africans, Mr Four is co-infected with TB and AIDS, a lethal marriage of disease that, without aggressive treatment, usually heralds the swift onset of severe illness and premature death. He has no idea how long he will survive, but he's well aware that if the groundbreaking pilot study he has chosen to participate in is successful, he may very well see his family grow to adulthood.
The project, known as START (Starting TB and Anti-retroviral Therapy) is, for the first time in South Africa, looking into the possibility of combining TB and AIDS medication in a setting like the Chest Clinic where treatment can be closely monitored.
"There have been very few published studies on combining TB and HIV therapies," said specialist physician Dr Chris Jack of the University of KwaZulu-Natal's Nelson R Mandela School of Medicine, who presented a poster on START at the Barcelona AIDS Conference in July this year. "The efficacy of the medications, when taken together, needs to be urgently assessed," said Jack. "We have to establish whether the taking of the drugs for both TB and AIDS increases toxicity levels in the co-infected and whether the toxicity profile is an important issue to be studied. If the combination therapy is well tolerated, it opens up a very promising avenue."
To ensure high ethical standards for the study, a number of TB patients attending the Chest Clinic were offered the opportunity of voluntary counselling and testing for HIV. Nursing sister Colleen Kanyane explains: "Trust is so important. I say to patients that if they have TB, there is a chance they are also HIV-positive. What we are offering is a chance to understand and test their infection status, and if positive, to do something about it."
The research team screened 92 patients, of whom 20 were co-infected. Patients in the pilot study are monitored on a weekly basis for any side-effects, while routine blood tests are conducted for liver toxicity. The combined dosage of 14 tablets is given once a day - five TB tablets daily, Monday to Friday, together with nine anti-retrovirals daily for the first two months. The TB dosage is then reduced to three tablets daily, Monday to Friday.
Although the study, which looks at the safety, possibility and acceptability of a combined regimen, is in the early stages, none of the patients, says Jack, has any noticeable liver toxicity profiles. "A few developed rashes, while in some there was dizziness. But all symptoms subsided within a few weeks."
Sister Kanyane said that one of the outcomes was the improved wellbeing of the patients. "To see people that were so sick and had lost all hope smiling again and eating well is like a miracle. If we can bring back hope, we can win the battle."
Funds for the project are from the Doris Duke Foundation and the Irene Diamond Organisation in New York.
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