Drugs resistance hampers war on HIV and cancer

Antimicrobial resistance, the term used to describe medication losing their power to cure, is threatening the management of HIV and cancer, health experts have warned.

Dr Eveline Wesangula of the Global Antibiotic Resistance Partnership (Garp) at the Ministry of Health says HIV patients need antibiotics to curb opportunistic infections, but are increasingly showing no signs of response to prescriptions.

And Dr Christine Bii, a mycologist at the Kenya Medical Research Institute (Kemri), says a special group of anti-fungals (Azole drugs), which are used to treat opportunistic infections that attack people with compromised immune systems, are the most affected by this resistance.

Antibiotics, modern medicine’s prized possessions, have been abused so much that they can no longer cure diseases that they once conquered. In 1998, 50 per cent of typhoid fever strains were resistant to the recommended antibiotics — ampicillin, chloramphenicol, tetracycline, streptomycin and cotrimoxazole — but that figure rose to 82 in certain parts of Thika, Embu and Nairobi by 2002.

There is not much hope in figures observed in other gastrointestinal infections.

This is particularly scary for fungus, against which a vaccine has never been developed. Dr Bii lists three micro-organisms — candida tropicalis, candida krusei and candida glabrata — that have been isolated at the microbiology centre at Kemri as resistant.

Bodies of healthy people can clear these kinds of micro-organisms immediately, but when one is immune-suppressed — because of diseases such as cancer or HIV — one is brought to one’s knees by harmless infections.

Studies by Dr Bii and her colleagues have found fungal pneumonia in 10 per cent of patients not on antiretroviral therapy. Another study found that cryptococcal meningitis was prevalent in six to 11 per cent people whose immune systems were suppressed.

The World Health Organisation (WHO) has warned that this resistance is “threatening every achievement of modern medicine”. Simple diseases that medicine had conquered, like pneumonia and malaria, now kill because pathogens have become “superbugs” — stronger and more agile.

According to the 2016 economic survey, pneumonia is already a leading killer in Kenya and claimed 22,473 lives in last year, with malaria (20,691) and tuberculosis (10,183) giving it a run for its money.

When TB becomes resistant, taxpayers pay as much as Sh2 million to treat one patient, and the National TB programme reported that there were nearly 900 drug-resistant TB infections in 2015.

Yet the public and, sometimes, the medical fraternity, make these micro-organisms this lethal. Pharmacist Eva Wesangula told HealthyNation that the public uses antibiotics inappropriately.

Kemri’s Prof Kariuki says the dosage prescribed is what enough to kill a pathogen. “When you stop taking it because you are feeling better, you expose yourself to danger because you only weakened rather than killed the bugs, so they will get up and the next time the drugs show up, the bugs will have changed form and become resistant.”

When this happens, the patient is given stronger and more expensive medication called second line antibiotics, and when that fails again, they get the prized possession of the medical fraternity, the first line and last resort called carbapenems, after which the medic will leave the patient to the hands of the Lord… or luck.

Researchers have long expressed the need to approach the matter from “all directions”. A multi-pronged approach where the pharmaceutical industry is forced to “pay or play”, and where companies would either research to develop new antibiotics or be prepared to fund other companies to do so, is one of them.

Already, some companies are active on the warfront. Dr William Mwiti, the medical director at GlaxoSmithKline (GSK) said that the company spent $1bn on antibiotics research and development in the past decade alone.