Antiretroviral therapy for HIV/AIDS

Human immune deficiency syndrome (HIV) is a pandemic condition. The incidence of new cases has been brought down due to extensive public awareness campaigns by WHO and various organisations. The prevalence in Rwanda is low as compared to many African countries(3%). This is due to increased public awareness, availability of ARV drugs and very well organised ARV services down to level of health centres. Antiretroviral drugs help to stop the multiplication of HIV virus and reduce the viral load in the body. Thus they help to clear the infection and improve quality of life. But to get full benefit from antiretroviral (ARV) therapy they have to be taken throughout life. There has to be good compliance with the treatment prescribed. In spite of easy availability of ARV drugs, some people still suffer from opportunistic infections, i.e. infections ( that occur due to reduced body immunity). These infections may be repetitive or severe life threatening, thus affecting the productivity and quality of life of a person. The main reason for these people falling sick is non adherence to ARV therapy. Many patients stop taking medicines once they start feeling good. After developing some sickness, they restart it again. But by this time, they may develop drug resistance and treatment failure. This necessitates change of drugs. If again, one is non compliant, he lands himself in a grave situation. Antiretroviral drugs, like any other drugs, do have some side effects. A person, when put on antiretroviral therapy is explained about the potential adverse effects of each drug. But at times, if an individual develops any adverse effect, instead of reporting to the health personnel, he simply stops taking the medicines. This reason is stated when he comes with some severe sickness. Three drugs are given in combination for HIV treatment, to ensure effective removal of the virus and minimise adverse effect of drugs. But I have come across some people, who out of ignorance, share ARV drugs with a spouse or partner, who does not wish to come forward for treatment. Underlying this sharing and even poor adherence is the problem of stigma. Though much efforts and counseling have been done by concerned agencies, still the traditional stigma associated with HIV/AIDS still persists in minds of many people. HIV positive people come for consultation for their sickness and deny their status. When tested and results come positive, then they say that they are already positive. Further questioning reveals that they have stopped the drugs for months or even years, for various reasons, including the stigma attached. A very sick patient with some opportunistic infection, does not disclose his status to even his family members. When tested, the results come positive. In this scenario, matter of concern is the innocent partner, who unknowingly becomes infected with HIV and comes to know very late about it, when prevention with ARV drugs becomes impossible. Though statistically, number of such people who are non adherent to ARV therapy may be reducing. But every infected case is 100% affected and carries potential risk of spreading infection to others. Measures taken by Ministry of Health to contain HIV infection and help affected people to have a good quality of life are laudable. Now it is for the people to make the best use of the options available. HIV/AIDS should be considered as a sickness like any other sickness. There is nothing to feel ashamed about it. When people start thinking that way, they will no longer try to hide their infection. They will also be more compliant with treatment and follow up. This shall help to reduce the burden of the disease further. The writer is a specialist in Internal Medicine at Ruhengeri Hospital