Panic after patient swallows expired drugs

By DANN OKOTH

A cold wave of panic ran through John Amitu’s spine when the doctor informed him that the Anti-retroviral (ARVs) medication he was under were expired and could harm his health if he continued to take them.

Horrified and scared for his life, Amitu promptly returned the medicine to MÈdecins Sans FrontiËres’ (MSF) clinic in Huruma in Nairobi. Although he did not suffer physical harm from consuming the medicine — the experience left him worried about the safety of the drugs he had been taking all along.

In recent times, people living with HIV/Aids have had to fight many injustices including protesting over frequent breakdown of CD4 machines. [PHOTOS: COURTESY]

"I remember it was only a few months after I started my medication following my diagnosis — which was a coincidence, really, because it happened when I took my wife for a routine check-up and she suggested we take a HIV test.

"It was a bit of a bombshell when the test returned positive for both of us, but again it was the best thing that ever happened to me because I would be worse off health-wise by now if I did not know my status. The message from the doctor was therefore a shock and setback in my treatment."

Feared for his life

Adds he: "What bothered me most is the impact on my health. I was also worried that if this could happen now, what about in the future when I am out of the programme and have to obtain the medicines on my own?" he observes.

He feared for his life, he says, especially after hearing that the HIV medicines had serious side effects — and were said to be even poisonous. He kept wondering what would happen to him since he had consumed the ‘dangerous’ expired drugs.

MSF’s missions in Kenya detected quality problems with the medicines used to treat people with HIV and Aid-related diseases after its nurses reported that the product was irregular in appearance; the tablets were friable and discoloured.

The medicine (Zidolam-N) were actually expired medicines that had been deliberately re-labelled to alter the expiry data and re-introduced into the medication supply by an individual or individuals.

Negative outcomes

Thankfully, in this case, says MSF head of mission in Kenya Richard Veerman, the falsified medicines did not seem to have significant negative outcomes for the HIV control of patients, neither did they result in treatment failure. "However, the events in this case were upsetting to patients and staff alike," he says.

"And a former advisor to the government on HIV and Aids treatment has warned that fake and falsified ARVs circulating in the country could be a costly affair for the government.

Dr Dundu Malaki Owili, a dermatologist at the Aga Khan University Hospital, says the infiltration of uncertified drugs into the system would lead to mass drugs resistances among patients making HIV and Aids too expensive to treat.

"Fake or expired drugs do not work, so the virus continues to multiply in the patients. Such drugs also lead to patients developing resistance to treatment meaning they would have to be put on second line treatment which are several hundred times more expensive," he says.

"The patients would also have to undergo numerous and expensive CD4 and viral load tests making the cost of their treatment quite high and almost untenable," he adds.

Call back

Veerman says after their nurses identified the problem with the medicines, MSF immediately informed the appropriate Kenyan authorities and the WHO, and then rapidly obtained sufficient quantities of replacement medicine and began to call back patients for exchange of their medicines.

In all, MSF followed up nearly 3,000 of the HIV patients who received ARVs from falsified batches and provided them with replacement drugs. These patients were also offered an evaluation to ensure their health wasn’t affected.

The organisation will continue monitoring them closely and also offer both clinical and biological examinations, such as viral load tests.

Meanwhile, an official investigation is ongoing.