A review on the occurrence, ecotoxicology and biodegradation of antiretroviral drugs in wastewaters: A South African perspective

South Africa's high HIV-1 prevalence has resulted in one of the world's largest antiretroviral therapy programs, leading to detectable levels of antiretroviral drugs (ARVs) in aquatic environments due to inadequate wastewater treatment. This review critically examines the occurrence, ecotoxicological risks, and removal inefficiencies of ARVs in South African water systems, while evaluating current treatment limitations. A microbial degradation approach is proposed as a sustainable remediation strategy, complemented by an integrated bioconversion process for expired ARVs. The proposed system combines non-thermal plasma (NTP) pretreatment with microbial metabolism with tailored microbial consortia to degrade even persistent ARVs like dolutegravir while also producing value-added products, aligning with United Nations Sustainable Development Goals (SDG) 6 and 12. This integrated effort directly supports Sustainable Development Goal (SDG) 6 by promoting clean water and sanitation, and SDG 12 by valorization of ARV input mass into useful metabolites, reducing ARV waste. Additionally, a genomic-proteomic-metabolomic framework is presented to elucidate degradation pathways and identify recoverable metabolites, offering a novel solution to ARV pollution that supports circular economy principles.