The United States will provide HIV medications to Colombia to help that country treat Venezuelan migrants fleeing their country’s turmoil and lack of antiretrovirals, U.S. Health and Human Services (HHS) Secretary Alex M. Azar said, according to Reuters. The announcement came in the wake of a regional conference in Cúcuta, Colombia, attended by health ministers from various countries in Latin America and the Caribbean (English version), as well as Azar. After conference attendees toured facilities for Venezuelan refugees in this border city, Colombia’s Minister of Health and Social Protection, Juan Pablo Uribe Restrepo, asked for international help to handle the refugee crisis in his country, according to the ministry’s press release: “We invite the international community to accompany us and help us make this a regional and global matter that deserves the effort of all countries.”
Mortality rates among Venezuelan migrants living with HIV have steadily risen in the Norte de Santander department of Colombia, where Cúcuta is located, the Center for Global Health reports. In 2015, nine such deaths were reported. By comparison, 72 migrants living with HIV died in the first 10 weeks of 2019 alone. The report recommends, among other things, reducing bureaucratic hurdles for importing donated HIV medications.
“When I was there I actually signed a letter of intent with minister of health Juan Pablo Uribe for the United States to be providing HIV antiretrovirals to Colombia for the use with Venezuelan refugees,” said Secretary Azar. Reuters reports that 12,000 doses of antiretrovirals would be donated, quoting an HHS spokesperson who claimed that this would treat 1,000 people for a year.
However, according to the American Medical Association’s style guide, a “dose” is a single pill, while “dosage” refers to a specific amount of medication to be taken over a certain period, such as a 30-day supply of a drug, Roy M. Gulick, M.D., M.P.H., of Weill Cornell Medicine explained in an email. “So, I’m guessing the HHS spokesperson said (or meant) ‘dosages’ and meant a month-long course — that’s the only way the math adds up,” he added. In a statement, 12,000 “units” are promised, without specifying the content of such a “unit.”
“Subject to congressional notification and approval, and working closely with the government of Colombia, PEPFAR intends to provide 12,000 units of lifesaving antiretroviral medication (dolutegravir/tenofovir/emtricitabine), enough to serve 1,000 patients for a year, to assist HIV-positive Venezuelan refugees in Colombia,” said a spokesperson from the President’s Emergency Plan for AIDS Relief (PEPFAR) in an email to TheBody. “The medications are expected to arrive in the next several months.”
TheBody previously reported on Venezuelans living with HIV fleeing to Colombia in search of antiretrovirals, which are scarce in their own country. Colombian HIV organizations have formed partnerships with their Venezuelan counterparts to guide migrants to resources, but organizations provide treatment by getting migrants living with HIV into the Colombian public health system, Miguel Ángel Barriga Talero of Colombia’s Red Somos explained at the Community Forum ahead of the International AIDS Society Conference on HIV Science (IAS 2019) this year in Mexico City.
In Venezuela, the preferred antiretroviral regimen is tenofovir + lamivudine + dolutegravir (TLD), Alberto Nieves of Acción Ciudadana Contra el SIDA in Venezuela explained at that forum. However, many people are already on their second or third regimen, and none of the medications for alternative regimens are available in his country, he said. At IAS 2019 itself, Mario Comegna, M.D., of Sociedad Venezolana de Infectología in Venezuela, appealed for rescue treatment combinations, explaining that 499,980 people in Venezuela had experienced treatment failure on TLD by the end of 2018. As of Jan. 31, 2019, an estimated 8,824 Venezuelans lived with HIV in Colombia, Talero said at the forum. Presumably, some of these migrants need alternatives to the first-line regimen.
Thus, in several months, the promised U.S. donation will provide roughly one in nine refugees living with HIV in Colombia with a somewhat different fixed-dose combination from the one on which they started — assuming they haven’t developed resistance in the meantime. The announced gesture of help also relies on approval by the U.S. Congress and on overcoming Colombian bureaucratic hurdles.