HEALTH SERIES: HIV/AIDS Pt 4 – Management and Prognosis of HIV – Dr.Chin Akano

 

This is the concluding part to the HIV/AIDS series. In this article I shall be discussing  how to manage HIV infection and its prognosis.

MANAGEMENT:

 

I know that some people want to know if HIV infection is still a dead sentence? My answer is NO.

With early diagnosis and proper treatment, HIV positive individuals can live a fairly normal live just like other sufferers of  chronic diseases.

Before i go any further, i must emphasise that there is no cure for HIV, but there are treatments that are available to most  people with the virus to enable them live long  healthy lives.

My advice is that all at risk individuals should take a HIV test and if found to be infected, should see a properly qualified doctor trained in the management of HIV infection immediately.

I also like to state that current drug regimens are unable to completely eradicate HIV infection. If you withdrew your treatment, HIV viral loads rebound quickly with a concomitant decline in your CD4 count which, in most cases, without a resumption of treatment, leads to late or advanced stages of HIV aka AIDS.

Let me discuss with you what you expect when you visit the doctor after being diagnosed with HIV infection. In most countries of the world you would receive some counselling , then serial blood tests and medication when indicated.

 

IF YOU TEST POSITIVE:

You will have regular blood tests to monitor the progress of the virus before starting treatment.

You will not normally need to start treatment until the virus has begun weakening your immune system. This is usually assessed by checking your CD4 count and also how ill you are.

Like i said in part 3 of this series CD4 cells are infection-fighting cells in your blood.

In the US and UK treatment is usually recommended to begin when your CD4 count falls below 350, whether or not you have any symptoms.

The aim of the treatment is to reduce the level of HIV in the blood and prevent or delay the progression of your HIV to the late stage or advanced HIV previously referred to as AIDS.

Once HIV treatment is started, you are likely to take the medication for the rest of your life.

For the treatment to be effective, it will need to be taken on time every time.

 

Your doctor will normally prescribe for you a cocktail of drug treatment known as highly active antiretroviral therapy (HAART)

 

You will be put on at least three (3) drugs belonging to at least two types or classes of anti retroviral agents.

Currently there are three commonly used classes of anti-retroviral agents which are as follows:

 

* NARTIs which stands for nucleoside analogue reverse transcriptase inhibitors. Some may also abbreviate it as NRTIs.

* Protease inhibitors

* NNRTI which stands for non -nucleoside reverse transcriptase inhibitor

 

For those resistant to these common agents above, there is a new class of anti retroviral agent known as entry inhibitors available for use.

 

Do these medication have side effects?

Like every medication, these antiretroviral have side effects. Some of the common ones are as follows:

  • Nausea

  • Vomiting

  • Diarrhoea

  • Tiredness

  • Skin rashes

  • Mood changes

  • Fat gain on one part of your body while loosing fat in another part. 


ISSUES ABOUT TIMING OF TREATMENT

Some believe that treatment should be started as soon as HIV infection is diagnosed while some others argue that treatment should only be started when the CD4 count is less than 500.

Starting treatment therefore depends on the viral load, how fast the CD4 count declined and the patients readiness to commence treatment

However some studies have shown that death rates are almost twice as high when therapy is deferred (until the CD4 count falls below 500) compared to starting therapy when the CD4 count is above 500.

Whatever the case may be, AIDS progression in children in particular, young infants is more rapid and less predictable than in adults.  So, more aggressive treatment is recommended for children than adults.

 

Prognosis

I shall be discussing the life expectancy of HIV positive individuals and how proper treatment affects it.

Evidence has shown that without treatment with the highly active anti retroviral therapy (HAART) progression from time of infection to the advanced stage (AIDS) occurs within 9 to 10 years.

And when the individual develops AIDS, without treatment with HAART, on the average most will die in less than 10 months of developing it.

So it means that without treatment with HAART, most HIV positive individuals would die within 9 to 11 years of being infected.

The good news is that one study has shown that if HAART is started when the CD4 count is around 350, then the average life expectancy of most HIV positive patients is 32 years from the time of infection, the range is 20-50 years.

Life expectancy is further enhanced if therapy is initiated before the CD4 count falls below 500.

The HAART treatment has reduced the death rate of  HIV infection by about 80%. Which means that, even with effective treatment, HIV positive individuals can still die from   advanced or late stage of HIV infection otherwise known as AIDS.

Thanks for reading.

Dr.Chin Akano

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