The ManicaPost
Catherine Murombedzi
TREATMENT failure for people living with HIV is not anything new. It can be caused by missing doses which is called defaulting.
One can miss doses after forgetting to do so or when one will have travelled and forget to carry medication with them. One can miss tablets due to pill fatigue.
One can also miss doses due to drunkenness or substance abuse.
Lately people are stopping treatment after believing that they would have been spiritually healed. This is after faith healers would have preached to them that by their faith they are healed. This is wrong because by nature the HIV virus multiples when medication is stopped.
Drug resistance and toxicology can cause treatment failure too.
When treatment fails, it means that the immune system is now under attack as the CD4 count drops.
CD4 cells are the protective cells in the blood which fight diseases. They are like soldiers defending the body from enemies. These soldiers make up the army in the body which is the immune system. The HIV virus destroys these soldiers on entering the system.
ARVs help suppress the virus, thereby restoring the immune system.
When treatment fails, it means replication of the virus again. There are a myriad of causes to treatment failure.
The golden standard to test treatment success/failure is through a monitoring system of the blood called viral load. (VL)
I experienced treatment failure recently. I was not ill, but experienced weight loss. I adhered 100 percent so was surprised by the treatment failure.
The results after the VL testing showed that my CD4 count was at 85 low. The viral load had mutated and stood at 38 000ml copies per gram.
It meant I could fall ill, very ill any moment. I had been on treatment with no challenge since 2009.
I last had a VL in 2013.
Nevirapine and zidovudine were no longer working, the test revealed. Only lamuvidine was still working.
The failing drugs had to be replaced. I now have atazanavir, tenofovir and lamuvidine. I have been monitored for the past six weeks and my viral load is now falling. The nursing sister at Newlands Clinic (where I was referred after treatment failure) a lovely person Sister Rose, said my VL will be suppressed in three months time if medication is working well.
Dr Owen Mugurungi the Director in the AIDS and TB unit, said treatment failure was caused by a number of issues.
He said a drug may fail to suppress the virus resulting in treatment failure.
“Treatment failure is when an ARV regimen is unable to control HIV infection. Treatment failure can be clinical failure, immunological failure, Vito logical failure or any combination of the three,” said Dr Mugurungi.
He said poor adherence also played a major role in treatment success.
“Factors that contribute to treatment failure include drug resistance, drug toxicity, or poor adherence,” said Dr Mugurungi.
Dr Mugurungi said treatment failure could result in less uptake of required drug quantity.
“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 uptake of the medicines and therefore subsequent insufficient ARV in your system that led to the resistance,” he explained.
He stressed that viral load monitoring was necessary in managing a person on ART.
“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,” he said.
Dr Mugurungi said if medicine fails to work, then it has to be changed.
“If not then they can be quickly changed or switched,” he added.
Viral load testing is the standard golden test. However, in Zimbabwe it is available from private laboratories at $100 which is dear for many people.
Mission hospitals offer VL to their clients. District and Provincial hospitals also have the facility. Not everyone is a client at mission, district and provincial centres.
The majority are catered for at smaller institutions and clinics which do not have VL testing.
Therefore of the 1.2 million people living with HIV, less than a quarter have accessed VL.
There is a danger that treatment failure will be noticed when one falls ill and can lead to loss of life.
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