ARVs Water Impact: Examining the Environmental Consequences of Antiretroviral Drugs in South Africa’s Water Systems

By João L. Carapinha

July 29, 2025

A study by North-West University found high levels of HIV antiretrovirals (ARVs) in South African water systems. The ARVs lopinavir and efavirenz were detected downstream of wastewater plants, exceeding safety limits. These pose risks to aquatic life, such as altered snail development and disrupted bacteriophages. Authorities claim current standards protect human health.

Key Insights

Lopinavir and efavirenz were the most common ARVs found, at 38 μg/L and 24 μg/L. Wastewater systems cannot remove these drugs, and the resultant environmental effects include bacterial blooms and harm to non-target species. Long-term risks to ecosystems and humans are unclear.

South Africa’s HIV program uses about 159,000 kg of ARVs yearly. Around 30% enters water via sewage, and treatment plants are not designed to filter these drugs. Global research labels ARVs as contaminants of concern and current standards ignore such pollutants.

Implications

This crisis requires interdisciplinary solutions:

  1. Better wastewater tech (e.g., advanced oxidation) may help but could be costly.
  2. New regulations should set ARV discharge limits for environmental safety.
  3. Ongoing monitoring is needed to track risks like antimicrobial resistance.

The study highlights the balance between public health and environmental protection. Cross-sector collaboration is vital. For more, review the original findings on ARVs water impact.

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