Scientists reveal risks of ARVs in pork, birds

This misuse, scientists warn, presents serious dangers to public health by worsening the problem of drug resistance and increasing government spending on HIV/Aids care as the country shifts to new and more expensive medicines due to drug resistance.

According to the United Nations food agency, FAO, Ugandans on average eat 141 million kilogrammes of pork and 62 million kilogrammes of chicken, translating into 3.5kg and 1.5kg per capita pork and bird consumption, showing the widespread impact of the practice. 

The experts warned that this misuse of ARVs exposes unsuspecting HIV-negative consumers to adverse effects, including obesity, due to prolonged exposure to the drugs.

Our analysis of studies done in 11 districts by researchers from Makerere University between 2019 and 2021, found that somewhere from eight percent to 27.5 percent of the pigs and chickens are fed on ARVs.

One of the researchers, Dr Hussein Oria, a lecturer at Makerere University department of pharmacy, told this newspaper that the farmers are involved in this unethical and dangerous practice for economic gains.

“Farmers use this product [ARV] because they are looking at fast growth and also getting quick returns. Their belief is that these products cause weight gain in humans and so it will likely cause weight gain in animals, making them get heavier animals and get more returns,” he said.

In the study he did on six farms in Wakiso District, Dr Oria said he found 13 percent of sampled chicken tissues [meat] having ARV residues, meaning the birds were fed on the medicines. He said they also found ARV traces in three percent of commercial animal feeds.

Kampala and Lira

Another study in Kampala and Lira, which Ms Ritah Nakato led from Makerere University College of Health Science, detected ARV residue on 27.5 percent of the 361 samples from pig abattoirs.

Mr Dickson Ndoboli, another researcher at Makerere University College of Veterinary Medicine, in his study in 10 districts in eastern, northern and central Uganda, said “all groups [study participants] reported the use of ARVs in pigs and broiler birds, but not in layer hens”.

“Eleven out of 200 pork and chicken samples (5.5 percent) tested positive for residues of saquinavir, and 5/200 pork and chicken samples (2.5 percent) tested positive for lopinavir [both ARV drugs],” the report of the study done along with other international researchers reads in part.

Both the National Drug Authority (NDA) and Uganda National Bureau of Standards (UNBS) said these issues have been reported to them. But the Agriculture minister, Mr Frank Tumwebaze, and the President of the Uganda National Farmers Federation (UNFFE), Dr Dick Kamuganga, told this newspaper they were not aware of the practice.

ARVs on sale

Dr Oria said the common source of ARV drugs was health facilities.

“People claim they are buying the ARVs from health facilities, but also, a patient can visit more than one facility and get excess of the medicines [they sell],” he said.

“Also for HIV/Aids patients who die, their medicines are not returned to the health facilities [so some families retail the medicine]. That is another source,” he added.

Dr Jeanne Muhindo Bukeka, the National Drug Authority (NDA) head of veterinary products, said the medicines are coming from patients and some controlled sources which they are investigating.

“We are aware of it happening. It is unethical, it is a misuse. ARVs are very controlled drugs. We found out that the patients themselves are willing to sacrifice for their animals, but now for this particular report, I see them saying it is even in feeds, meaning it is an intentional move. If it is being put in bigger feeds, it means someone is accessing it from a controlled source,” she said.

Mr Abiaz Rwamwiri, the spokesperson of NDA, the statutory drug regulator, describing the practice as “grave ethical misconduct”, said NDA has been following up the claim that some people are mixing ARVs for animal or poultry feeds. He said it increases public health risks.

“We have been sensitising farmers about the dangers, but now it has gone commercial and that is why we have moved to engage with the Agriculture ministry that is charged with animal feeds to have coordinated enforcement operations against such criminals risking the lives of Ugandans,” he said.

He added: “We have intelligence that these ARVs are illegally accessed from health centres which deny patients the opportunity to get the needed care.”

But Mr Tumwebaze said he had not heard about the issue.

The UNBS executive director, Mr David Livingstone Ebiru, said although they are aware of the practice, it is hard to control.

“We control the quality of feeds imported through Pre-Export Verification of Conformity to Standards Programme (PVOC),” he said, adding: “Farmer education is required by the Agriculture ministry. We cannot control the adulteration of good feeds at individual levels. This is the personal ethics of each farmer. Our laboratories can test for all these.”

Risks of ARV in pork

Dr Oria said medicines are very expensive and so must be used rationally.

“When we control ARVs very well in these health facilities, we can mitigate that [misuse]. We need to first identify the patients that receive the medicines so that the same person doesn’t pick medicine from more than one health facility. This requires an IT system to implement,” he said.

Some people revealed to different researchers that they register in different health facilities and so can pick medicine from either of them or from all of them.

“When you misuse ARVs in farm animals, the tissues [meat] will eventually have ARVs and yet people consume these tissues [meat]. They end up taking trace amounts of these ARV medicines which will cause drug resistance in people with HIV/Aids,” he said.

A recent study by Christine Watera from the Uganda Virus Research Institute found that HIV/Aids drug resistance prevalence was at 18 percent among the 491 participants tested and some people were even resistant to the drugs before treatment initiation, thus signaling previous exposure to the drugs.

“That [drug resistance] will increase the cost of care because the person cannot be treated on first-line medicine. They must go to the second line which is very expensive and not many governments can afford second-line treatment,” explained Dr Oria, a former president of the Pharmaceutical Society of Uganda and a graduate of Imperial College London.

He added: “So majority use first line treatment which is cheap, affordable and accessible. The second line is more costly and this will increase the cost of care. And if the virus is resistant to the medicine, people can actually die because you are not getting cured.”

In Uganda, for a twelve-month supply per person, first-line drugs cost somewhere from $72 (Shs270,000) to $124 (Shs466,000) while second-line drugs cost from $100 (Shs367,000) to $300 (Shs1.1m), according to a 2020 report by United States Agency for International Development, one of the major funders of Uganda’s HIV/Aids response.

According to the Uganda Aids Commission, there are around 1.4m people with HIV/Aids, and about 22,000 Aids-related deaths and 38,000 infections are registered annually. Ninety percent of the persons with HIV are on treatment, but from this, around 18 percent have an unsuppressed viral load, indicating lapses in adherence to medication.

Different researches so far majorly done in uninfected children of HIV-positive mothers, have found adverse effects of exposure to ARVs among the uninfected, stretching from liver disease to reduced immunity and stunted growth. The studies were done by Christiana Smith of America and Adriane Delicio of Brazil, among others.

Prof Fred Kabi, a researcher at Makerere University College of Agricultural and Environmental Sciences, said leaders of farmers and the government should bring producers up to speed about the need to protect their consumers.

“But if you are dealing with desperate people [farmers] who don’t care about the safety of their consumers, it is terrible. UNBS should develop standards to control this by intercepting adulterated animal products,” he said.

“I know enforcement will be a problem, but they should have equipment and facilities to test and intercept adulterated products. It is an area that needs more research to come up with a gadget that can detect this [with ease],” he added.