The Department of Water and Sanitation (DWS) has assured the public that the presence of anti-retroviral (ARV) residues in drinking water poses no health risk and cannot result in HIV transmission.
Image credit: NIAID.
This follows the release of a study by North West University’s Unit for Environmental Sciences and Management and the Africa Unit for Transdisciplinary Health Research, which found measurable levels of ARV residues in some South African water sources.
Ongoing research
The report, titled Quantification, Fate, and Hazard Assessment of HIV-ARVs in Water Resources, revealed that ARVs are entering the water supply primarily through municipal wastewater treatment systems.
These facilities, originally not designed to eliminate such pharmaceutical compounds, allow residues to enter rivers and drinking water sources.
The most detected ARVs included lopinavir and efavirenz, with concentrations at some sites far exceeding global norms.
Despite this, the department emphasised that the presence of ARV residues in drinking water is harmless. However, “prolonged exposure to the broader population may lead to antimicrobial resistance, a subject of ongoing research.”
In a joint statement with the Water Research Commission (WRC), the department noted that the appearance of ARVs in water is a result of South Africa’s massive programme to curb HIV and AIDS treatment programme.
As a result, traces of ARVs are entering municipal sewage systems and passing through these systems into rivers.
“Pharmaceuticals such as ARVs are drugs used to treat diseases -- they do not cause diseases. Therefore, the presence of traces of ARVs in the water will not result in people contracting HIV.
“At present, there is limited knowledge of environmental toxicity, potential adverse effects on ecosystems and viral resistance of these compounds. The study did not find any ARVs in fish,” the department said.
Emerging global challenge
The Water Research Commission, alongside local and international partner research organisations, has since the early 2000s commissioned several studies on the presence of contaminants of emerging concern (CECs) in water resources and drinking water.
The WRC’s research has focused on CECs such as microplastics, chemicals, and pharmaceuticals that could potentially pose risks to human health and the environment. These studies inform the water quality guidelines and regulations issued by DWS.
“However, CECs are a relatively new area of research globally, particularly relating to the causes and effects of CEC, the human health risks, treatment methods to remove CECs, and potential regulatory measures that can be taken to address the problem.”
The study, commissioned by the WRC and carried out by North West University, found that:
- Almost all the concentrations in drinking water samples at the test sites were below the limits of quantification. The most frequently detected compound was fluconazole (28 detections from 72 samples), with concentrations ranging between 0.06-1.8 μg/L (nanograms per litre).
- Nevirapine and efavirenz were the second most detected compounds, both with 22 detections out of 72 samples.
- However, on average, lopinavir and efavirenz had the highest concentrations of the compounds analysed, while didanosine and zidovudine were the least detected compounds (two and six detections out of 72 samples).
The department has also assured that the key water quality risks to human health of a biological and microbiological nature are well understood and regulated in South Africa.
“The South African National Standard SANS241 for water quality is based on World Health Organisation standards, ensuring that the human health risks are mitigated.
“This has enabled DWS to implement monitoring programmes such as the blue and green drop programmes to provide information to the public on the performance of municipal water and wastewater systems relative to SANS241.
“The traces of pharmaceuticals, microplastics and other such CECs that have been found in water resources in South Africa are very small quantities, measured in nanograms (one billionth of a gram).
"Conventional water and wastewater treatment technologies are designed to remove much larger contaminants such as particles of faeces and bacteria,” the department said.
