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SOUTH AFRICA: Controversial claims for vitamins undermine ARV rollout

[This report does not necessarily reflect the views of the United Nations]

JOHANNESBURG, 13 May (PLUSNEWS) - South Africa's AIDS lobby group, the Treatment Action Campaign (TAC), took controversial vitamin salesman Dr Matthias Rath to court on Friday, to stop him from claiming that TAC is bankrolled by the pharmaceutical industry to promote antiretroviral (ARVs) drugs.

Legal battles are not new to the group, which has faced off against the government over its delays in rolling out a public treatment programme.

With about 42,000 people currently receiving the drugs, the government is now close to meeting its target of providing treatment to 53,000 - admittedly a few months past the deadline.

But a new controversy has emerged - this time triggered by Dr Matthias Rath, a wealthy German whose products are banned in several Western countries.

Over the past year Rath has run a high-profile media campaign attacking ARVs and TAC, saying the anti-AIDS medication was poisonous, and multivitamins alone could prevent AIDS.

Several studies have been carried out to investigate the role of micronutrient supplements in the course of HIV/AIDS, but the results have not been conclusive.

But Rath's claims have apparently attracted an audience. AIDS denialists and the Traditional Healers Organisation have come out in support of Rath, going so far as to stage protests and distribute pamphlets and posters in Khayelitsha and other townships in the Western Cape.

"There are vulnerable people out there who are going to fall prey to Rath's strong promotions," Dr Des Martin, head of the South African HIV Clinician's Society, told PlusNews.

The TAC, the South African Medical Association, the Southern African HIV Clinicians Society, and the World Health Organisation (WHO), the UN Children's Fund (UNICEF) and UNAIDS have all condemned Rath. In a joint statement, WHO, UNICEF and UNAIDS described Rath's claims as "misleading and potentially dangerous".

Martin also noted that recent comments by health minister Manto Tshabalala-Msimang "are not helpful at all".

In April Tshabalala-Msimang told journalists that Rath's work was not undermining the government's position on HIV/AIDS treatment, but rather supporting it by promoting vitamins and micronutrients.

Earlier this month the minister was reported as saying that people were dying as a result of the toxic side effects of ARVs.

Martin warned: "Any controversy regarding therapy is going to unsettle the minds of the population at large. When people in high-profile positions come out and make such statements, this will have a very negative impact on the efforts of dedicated healthcare workers."

He also expressed concern that Rath, with his commercial interest in selling vitamins, was doing more than promoting nutrition, and health regulatory bodies had been slow in acting against him.

According to the TAC, Rath is prescribing some vitamins in excess of their recommended daily allowance, and vitamin C far beyond safe levels. According to the US National Institutes for Health, amounts greater than 2,000 mg per day can cause diarrhoea; Rath has prescribed more than twice that limit to people attending his clinics, which are not registered with any South African regulatory body.

This week the Medicines Control Council and the health department announced that they had launched an investigation into the activities of the Dr Rath Health Foundation.

NUTRITION VS ARVs?

The issue of nutrition has been marginalised by a damaging debate that has tended to frame it in opposition to ARV drugs.

The health minister herself has championed the eating of beetroot, garlic and olive oil, as a way of delaying AIDS progression.

But now, "patients are getting mixed signals about the relative importance of good nutrition in relation to ARVs," Professor Salim Abdool-Karrim, deputy vice-chancellor of the University of KwaZulu-Natal (UKZN) and a world-renowned clinical epidemiologist, told PlusNews.

This controversy "unfortunately presents a polemic of good nutrition instead of ARVs", he noted. "Good nutrition is important for the overall care of HIV-positive people, whether they are on ARVs or not," he stressed.

In addition, by repeatedly dwelling on the side effects rather than the benefits of the drugs, Tshabalala-Msimang was undermining the value of ARVs.

Her assertions that people were dying from the side effects of the drugs "are based on her dissident opinions - not on facts", said Abdool-Karrim. The UKZN's AIDS research programme, which provides treatment to about 400 people living with HIV/AIDS, "just doesn't see any of this [people dying from the side effects of ARVs]".

Admitting that "some toxicity does exist [with ARVs] - just as it exists with a lot of other treatments of fatal diseases, like chemotherapy", Martin commented that "we monitor for side-effects and deal with them, if and when they arise".

International NGO Medecins Sans Frontieres (MSF), which runs three HIV/AIDS clinics in Khayelitsha treating nearly 2,000 adults and children, found that after three years on ARV therapy, four in every five patients taking the drugs were still alive. Almost all deaths were attributed to the advanced stage of disease.

In three years, only one in 10 patients has had to change one of the three drugs they were taking, due to side effects, with good clinical response to the treatment change. Only four deaths could be directly associated to drug toxicity.

"People are extremely confused [over the Rath debate]. It's wishful thinking that people can defend themselves from such misinformation ... they are really vulnerable," Marta Dader, an MSF pharmacist, told PlusNews.

"The rollout is still in its very early stages ... it needs one voice to get people to participate. It's extremely complex and incredibly comprehensive; it doesn't help that there is this confusion," she commented.

In a statement MSF called on the health ministry "to recognise the plight of people in advanced stages of HIV infection by unequivocally stating that nutrition alone will not save them from death. For them, ARV therapy remains the only hope for survival."

[ENDS]