Dr Kay Mahomed:
Why I’m optimistic about HIV care
For the last 20 years, Dr Kay Mahomed has been involved in HIV care, including a ten-year stint running her HIV practice at Netcare Garden City Hospital in Brixton, Johannesburg. We spoke to her about her about the phenomenal changes in her daily practice brought about by PrEP, next-gen ARVs and the prospect of an undetectable viral load.
Medical Academic (MA): Hi Dr Mahomed. You have expressed quite some excitement about the state of HIV care. Could you elaborate why?
Dr Kay Mahomed (KM): I say to all my patients, just go out, live your best life and worry about everything else except your HIV. Nowadays if you test positive, HIV means a load of nothing. Once you're on ARVs, the most important thing in your life is not your HIV status but your viral load.
If that viral load is undetectable, it means you can lead a completely normal life: even if your partner is negative and you never used a condom, your partner will continue to remain HIV negative. So, this is the space we're in with HIV-positive patients. In terms of the HIV-negative patients, we have what we call PrEP available.
I'm extremely excited about PrEP going forward, because we have an oral formulation called tenofovir disoproxil fumarate (TDF). It is a small tablet with high concentrations of PeEP medication. And recently we've seen PrEP injectables being launched, which is fantastic. The injectable medications are twice yearly.
Initially I thought that injectables would be a pie-in-the-sky notion, because it would so expensive. But Gilead has, to their credit, let the price drop considerably and I think 2025 is going to be a bumper year for this therapy, because right now it’s being sold dirt cheap.
MA: First-line therapy is still ARV-based. Could you elaborate on the progress made in that regard?
KM: Certainly, in fact I think ARVs have been the biggest winner in the HIV story. You have to understand, in the old days, we would give patients handfuls of ARVs in the morning and handfuls at night. They would have severe side effects and toxicities - not anymore. The new ARVs we have, the fixed-dose combinations, are usually given in the form of one pill a day - two at most! And the pills are extremely tiny.
There are no side effects, no toxicities. But most importantly the new drugs are super effective, with a high genetic barrier to resistance. The new drugs are also TB compatible, liver compatible, renal compatible. So we're just winning at every turn.
And we want everyone to understand this because these drugs effectively make someone with HIV capable of functioning exactly like someone who is HIV-negative. HIV-positive patients can even donate organs that we can use in transplants, if they have an undetectable viral load.
“The new drugs are super effective, with a high genetic barrier to resistance; they’re TB-compatible, liver-compatible, renal-compatible. So we're just winning at every turn.”
MA: Do you have any cases of successful treatment you would like to share?
KM: Sure, one of my favourite cases was a little 10-year-old boy, let’s call him Daniel*. He was born with HIV, and his disease had never been suppressed. Eventually, he ended up with me and we switched his meds. I said to him, Daniel, after four months we're going to repeat your bloods, and if your bloods are good, then grandma is going to have to give you R50 for me and a big kiss.
And four months later Daniel said: “My grannie says you have to give me R50 rands and you have to give both of us a big kiss. And I said Daniel, I didn't say I'm kissing your grandmother! I said I was going to give you a big kiss. And that’s a common story: ten years on ARVs, never suppressed, but place the patient on the new meds and voila.
I still Daniel regularly and he is a very health-conscious little boy. The other patient that comes to mind immediately was a patient I knew off and on who was on a ventilator when we initially met. He is doing so well now. The only problem I have with him now is that when he comes into my rooms, he doesn't ask to see his doctor, he asks to see his darling!
My whole practice is just full of these wonderful stories. I remember a patient who was unbelievably underweight when she first came to my practice. Her brother carried her into the rooms. She has done so well on treatment, I can't even tell you. She lost her job during COVID and ended up learning French at the Alliance Francaise. Now she works for a French company in South Africa. And then to top it all off she ran the Comrades Marathon!
So, I take a lot of inspiration from my patients. And I am proud to say that every single patient in my practice viral load is undetectable.
* Name altered to preserve anonymity.
“If that viral load is undetectable, it means you can lead a completely normal life: even if your partner is negative and you never used a condom, your partner will continue to remain HIV negative.”
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