Somebody was very desperate after knowing the seropositive status for HIV. This person had started self medication in a bid to cure the disease in the early stages (as per the patient’s definition, the stage when tested positive). “From where did you get the medicines”? This was my question. The answer was that someone known had obliged by sharing medicines. This may not be an isolated case. Out of ignorance, desperation or greed for immediate, “cure”, some others may also be doing the same. Infection by Human immune deficiency virus (HIV) has become a well known condition world over. But still people are ignorant about the management of this illness. About 400 years ago a French man Nostradamus had prophesized that at the end of 20th century, because of indiscreet, unnatural behavior of men a new disease will emerge. In this, resistance of men will be destroyed and these weak men or women will die untimely suffering much. As his other prophesies, this one also turned true. Much to the astonishment of experts, human immune deficiency virus was discovered in male homosexuals along the Caribbean coast, in 1981 and shortly later among the prostitutes of New York City who were suffering from strange fevers along with glandular swellings. Since this illness has come in a way, on the invitation of human beings it is going to stay unless vigorous steps are taken by the people themselves. Some people are promiscuous and indiscreet in sexual relations. They contract the virus from somewhere and then pass it on to others. Mostly women become the innocent victims. Some get it unknowingly from barbers or other sources where some prick has been made or blood drawn unhygeinically. Children receive it as an unwanted gift from their HIV positive mothers. Whatever the source, all these persons become seropositive but not all will suffer from Aids i.e. the disease which develops due to HIV. Approximately 20% of seropositive cases may develop Aids over 5 years and about 50% may develop over 10 years. The other lot remaining may not develop Aids at all. But they remain seropositive throughout their lives and are at risk of infecting others. Development of the disease will depend on the life style factors (factors like promiscuity, drug abuse, e.t.c.) and CD4 count, (level of lymphocytes which determine the resistance of the body). A high CD4 count indicates that there is ordinarily no risk for developing infections. But it is necessary to get tested for CD4 every 3 to 6 months to know their level. Once the CD4 count come to 350 or below, prevention against common infectious illnesses is needed, which is provided in the form of regular use of anti infective agents like, Trimethoprim + sulphamethixizole ( Bactrim ) doxycycline or dapsone, in fixed doses. If the CD4 count improves later, they can be stopped. Here I have observed that if prophylactic medicines are stopped, many patients feel unhappy about it. Any problem they get after, maybe a headache or cold also, they say that it is because their medicine was stopped. But they should understand that these medicines are also not free from side effects. Long term use of Bactrim can cause anemia and kidney toxicity. They should be taken only when absolutely necessary, i.e. depending on the CD4 count. If one suffers from late stage (III and IV) diseases of Aids or the CD4 comes down to 200 or less, antiretroviral (ARV) therapy is started. It should be understood that these drugs prevent multiplication of the virus in the blood, keep the viral load low, but do not remove the virus altogether. Hence they have to be taken for life. They are given in combinations of 3 drugs to obtain maximum efficacy and prevent development of resistance. Therefore it is wise to take all the three drugs regularly in prescribed doses. On feeling better, a few people stop the medicines thinking that it is no longer necessary to take them. These people not only are at risk of developing infections but also resistance to the drugs. Later on when drugs are resumed, they no longer remain efficacious. Sharing of the drugs with friends or family is bad for everyone as nobody will be benefited in this; rather all involved can incur harm. Self medication without prescription or proper need is suicidal. One may actually need the drugs as per the criteria, he or she may have developed resistance to the medicines and then not many options are available for alternate antiretroviral therapy. Secondly by the time resistance to ARV is detected it may become too late for any active therapy and one may already have developed some end stage serious infection like, pnemocystis pneumonia, toxoplasmosis, e.t.c. Similar to other medicines, antiretroviral drugs also cause toxicity. Commonest toxic effects are peripheral neuropathy causing tingling and burning pain in the extremities, gastritis, anemia, liver toxicity, central obesity. Therefore if one takes medicines without proper indication he also exposes himself to these toxic effects. A word of caution, ARV therapy does not provide one with a license to have indiscreet, illicit sexual relations. In spite of taking therapy he is at the risk of transmitting the disease to others. Therefore he or she should be prudent enough. Women should say, “NO”, to sex without a condom. This will protect them from HIV and also other sexually transmitted diseases. On becoming pregnant they should get themselves tested and if positive, take ARV therapy for prevention of transmission of HIV to the baby. It is not only the patient but also his family members who are unknowingly exposed to the risk of infection, through nursing him and being exposed to his body secretions. Anyone with cut on the skin should avoid nursing an Aids patient. All contaminated linen used by the patient should be washed with hot water and disinfectant and dried out in good sunlight. If sunlight is not available it should be ironed thoroughly with a hot iron. Any spillage of secretions on the ground should be soaked on a tissue paper and burnt and the ground should be mopped with a disinfectant. Government of Rwanda has a national programme for HIV and Aids which is well implemented. Therefore this problem is well controlled here as compared to many other countries of the world. Only the need is for people to understand the disease better and make use of the knowledge and facilities available for prevention and good management of this deadly infection. rachna 212002@yahoo.co.uk
