The ManicaPost
Catherine Murombedzi
WHEN the HIV virus enters the blood it destroys the immune system by attacking the defence system which is the white blood cells. When white blood cells are destroyed we see the immune system failing.
When this happens one is prone to get opportunistic infections. Primarily tuberculosis, skin rashes, mouth thrash, pneumonia, diarrhoea and colds all those illnesses and many more will find an opportunity in the failed immune system.
The white blood cells act as a defence, the soldiers so to speak. When one tests HIV positive, one needs to be commenced on medication that restores the immune system. The tablets called anti retrovirals (ARVs) do not cure one of the infection but help suppress the virus thereby bringing back the immunity. These tablets are taken for life.
The tablets can work well or at times may fail to work for someone. It is not one size fits all. What works for one person may not work well for the other. Doctors and trained ART nurses are in a position to give out a best combination to patients.
One is tested to see if the liver and kidneys are functioning well before commencing ARVs. This standard procedure may be skipped in rural areas which are hard to reach as the need to put one on the lease of life may outweigh the procedure.
Usually, the ARVs work well for most people. This can be seen by having CD4 count tests done. Under normal circumstances these are done before commencing ARVs and used as a benchmark. After three months on ARVs, the tests are carried out again to see effectiveness of the given medication. For most if medication is correctly taken then the viral load goes down and CD4 count goes up.
For a person inconsistently taking medication there will be adherence problems as defaulting causes the tablets to be ineffective. For someone even taking medication correctly the tablets may fail to suppress the virus too and one has to change the combination.
When ARVs fail to suppress the virus we say there is treatment failure. Treatment failure is when an ARV regimen is unable to control HIV infection. Director in the Ministry of Health and Child Care in the AIDS and TB Unit, Dr Owen Mugurungi, explained what treatment failure is. “Treatment failure can be clinical failure, immunological failure, Vito logical failure or any combination of the three factors that contribute to treatment failure include drug resistance, drug toxicity or poor adherence,” said Dr Mugurungi.
I had experienced treatment failure resulting in weight loss. I adhered since 2009, but by year end 2016 was losing weight unexplained. My doctor referred me to Newlands Clinic in Harare where toxicology tests, liver test function, kidneys, viral load and CD4 tests were done.
My viral load stood at 38500mcopies. My CD4 count at a low of 85. Luckily, I was not ill. I had developed resistance to nevirapine and zidovudine. I took my medication consistently and correctly.
The two failing drugs were replaced with AZT and tenofovar. On May 30, three months after the changed medication my CD4 is 750 and the viral load now undetectable. The virus has been suppressed.
Dr Mugurungi explained what happened to me. “As you can see although you were adherent, maybe the HIV virus became resistant to the medication or you had drug toxicities that contributed to less up take of the medicines and therefore subsequent insufficient ARV in your system that led to the resistance,” he said.
He pointed out the importance of having a viral load (VL) done. “That is why it is important to monitor VL suppression in person taking ARV. If previously suppressed VL begins to rise, then it will show us that there is a problem. An ARV drug resistance test will be done to see if the medicines are still working or not. If not then they can be quickly changed or switched,” said Dr Mugurungi.
How many people are out there taking ARVs and have not had a VL done? Next time enquire about the service at your health centre. It could save your life or of a dear one.
