By: Gofaone Motsamai
NWU researchers have completed a groundbreaking study that sheds light on the environmental implications of antiretroviral drugs (ARVs) in South Africa’s water resources. The report, “Quantification, fate, and hazard assessment of HIV-ARVs in water resources”, was submitted to the Water Research Commission (WRC) and is the most comprehensive study to date on the issue.
The research was conducted by the NWU’s Unit for Environmental Sciences and Management and the Africa Unit for Transdisciplinary Health Research. The team of experts included Prof Suranie Horn, Prof Rialet Pieters, Prof Henk Bouwman and Prof Petra Bester, among others. Their collaborative effort combined expertise from environmental, health and social sciences to address this pressing issue.
The study revealed significant concentrations of ARVs in water sources, particularly downstream of wastewater treatment plants. The drugs most frequently detected were lopinavir and efavirenz, with concentrations at some sites far exceeding global norms. This is attributed to South Africa’s large-scale HIV treatment programme, the most extensive of its kind worldwide.
The research highlighted alarming effects on aquatic ecosystems and wastewater management systems. Freshwater snails exposed to ARVs exhibited altered embryonic development, while bacteriophages – viruses critical to controlling bacteria in wastewater treatment – were significantly impacted.
Such disruptions could lead to bacterial bloom and reduced water quality. The report noted: "The consumption of any type of exogenous drug by any organism in sufficient quantities may intervene with the regulation of metabolic systems and bring about adverse effects. The presence of antiretrovirals in water can be considered a hidden or latent risk."
Further, the study highlighted the potential risks for human health: "Humans are also exposed to these compounds via drinking water, and at concentrations exceeding calculated hazard quotients. Although not found in this study, humans and other organisms may potentially ingest antiretrovirals and their breakdown products via aquatic organisms such as fish."
The team employed state-of-the-art analytical methods, including liquid chromatography/mass spectrometry, to quantify ARV levels in water. Their work also involved biological assays to assess the toxicological impacts of ARVs on non-target organisms and hazard assessments to evaluate risks to human health.
The findings
The study found that concentrations of ARVs in some water sources exceeded acceptable thresholds, posing potential long-term health risks to humans. The research team emphasised that current wastewater treatment processes are inadequate for removing these bioactive compounds, highlighting the need for technological advancements.
The report presented to the WRC includes several key recommendations. These include developing regulatory guidelines for ARV concentrations in water, improving wastewater treatment technologies, and conducting further research to understand the long-term ecological and human health impacts of these pharmaceuticals. In addition, the team advocates a multidisciplinary approach to address the intersections of public health and environmental sustainability.
This research marks a pivotal step in addressing the environmental consequences of pharmaceutical pollution. By documenting the unintended impacts of ARV treatments, the team has provided critical insights to policymakers and environmental scientists. Their work underscores the importance of balancing the need for widespread HIV treatment programmes with the necessity of protecting South Africa’s water resources and ecosystems.
This study sets a benchmark for future research, placing the NWU at the forefront of addressing environmental challenges linked to public health initiatives.
