One of South Africa’s most under-resourced hospitals has been named as the research base of a new Aids drug. David Shapshak, Evidence wa ka Ngobeni and Aaron Nicodemus report
Ga-Rankuwa is an unlikely place for an Aids breakthrough. The dusty, dishevelled hospital outside Pretoria has been almost abandoned by the health system, leaving it critically underfunded and understaffed.
Despite this, researchers this week announced positive results in a drug trial of a relatively inexpensive Aids drug, Inactivin, that may have extremely beneficial results for the millions of Aids sufferers in South Africa and on the continent.
However, one Aids expert cautioned that the evidence is still anecdotal and until more rigorous trials have been completed, the effects of this drug remain unknown.
What is most remarkable about Inactivin is how the researchers managed to conduct the trials in the veritable ruin of the hospital that has now become the drug’s primary centre of research, along with the Medical University of South Africa (Medunsa) and the department of virology at the University of Pretoria.
Professor Wimpie du Plooy and Dr Andries Lategan of Medunsa, who are directing the study, say that although the long-term effects of Inactivin are not yet known, the immediate effect on patients involved in the study has been dramatic.
They report that one patient who had been regularly admitted to hospitals for secondary infections caused by his weakened immune system has not visited one at all since the drug trial. Another patient’s condition “improved so dramatically that he has taken a new job, while yet another has been able to sleep normally for the first time in years”, Du Plooy said.
Two small groups of HIV-positive men were administered doses of Inactivin last August and November, over five consecutive days. In both tests, the amount of HIV in their bloodstreams decreased to almost zero.
After treatment, only one trial patient still showed signs of living HIV in the blood, and even that patient’s count was one viable virus per one million white blood cells. None of the other patients in the study were found to have any viable viruses present in plasma or white blood cells, according to the study.
The clinical trial did not reveal any side effects of Inactivin, and the Medicines Regulatory Authority has authorised the expansion of Inactivin trials in South Africa. The results of the latest trials are expected to be released soon. Another trial, still in the planning stages, would test an oral form of the drug and include HIV- positive women for the first time.
Inactivin was first discovered and developed by an Irish company called Colthurst Limited. The company then funded clinical trials through Medunsa.
The trials have resulted in plans to set up a special laboratory at Medunsa to make it possible to conduct every aspect of research on the drug.
Although Medunsa has experienced severe financial and infrastructural problems since its establishment 22 years ago in the heyday of apartheid to train black doctors, dentists and veterinarians, it has achieved remarkable success.
The university has produced about 50% of black health care professionals in South Africa – and most of its graduates work in the country at hospitals and clinics where their skills are most sorely needed.
Unlike the Witwatersrand University and the University of Pretoria medical schools, Medunsa has inadequate training hospitals for its students. Ga-Rankuwa hospital is attached to Medunsa, while the University of Pretoria has more than three training hospitals.
More than 23 Medunsa students surround one patient in wards during their practicals. Students say education at Medunsa is more theoretical than practical because of the situation at Ga-Rankuwa.
In 1995, an investigation by Parliament’s portfolio committee on health found that Ga- Rankuwa hospital was severely underresourced: it had no trauma unit, the outpatients department was “overcrowded and offered no privacy” and conditions in its morgue and kitchens were “appalling”.
But its report concluded that “given the financial and infrastructural restrictions, it is clear that Medunsa/Ga-Rankuwa is producing an exceptionally high calibre of work”.
Academic work at Medunsa is regularly disrupted by boycotts – and this year was no exception. In January management closed down the university when students boycotted in protest against the exclusion of students who had not paid fees last year. Students owe the university about R50-million.
In October last year, students abandoned classes following a dispute with management over the appointment of the university’s new rector. The boycott severely disrupted the final examinations.
n There have been several controversies over Aids treatments in South Africa. The most bitterly contested was Virodene, whose active ingredient was a solvent called dimethylformamide (DMF), that took the world by storm last January. However, the research methodology of the three University of Pretoria scientists who discovered it has been questioned, as has the questionable involvement of Minister of Health Nkosazana Zuma in supporting the drug’s attempts to be registered by the then Medicines Control Council.
Last year it emerged that DMF may actually activate HIV, as suggested in a study published in the journal, Aids Research and Human Retroviruses, in September 1997.
Another questionable approach involved oxytherapy, a procedure involving the “oxygenation” of blood in patients with Aids, muscular dystrophy and other diseases. Oxytherapy, or polyatomic apheresis, has been banned in the United States and several European countries, although it is apparently legal in Germany and elsewhere.
A local oxytherapy clinic counted African National Congress MP Winnie Madikizela- Mandela and former security branch policeman Paul Erasmus as its backers.
But perhaps the most controversial aspect of Aids treatment in the country has been the recent furore over Zuma’s refusal to administer AZT to pregnant mothers – a drug which could significantly reduce the transmission of the virus to babies – because of the cost.
The “drug cocktail” of AZT and other antiviral drugs like 3TC have proved effective in slowing down the development of Aids from HIV. The drug cocktail works not by eliminating the virus but suppressing it; patients who had believed Aids to be a death sentence found themselves returning to a relatively normal life.