I once had a patient who tested positive for HIV. This person had started self-medication in a bid to cure the disease in the early stages. “From where did you get the medicines?” I asked. They answered that an acquaintance had shared their medicines. This may not be an isolated case. Out of ignorance and desperation for an immediate “cure” others are doing the same. Infection by Human Immunodeficiency Virus (HIV) has become a well-known epidemic worldwide. But still people are ignorant about the management of this illness. Whatever the source of infection – through sex, blood transfusion, sharing needles, or transmission in the womb – all HIV-infected persons become seropositive. But not all contract AIDS, 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 lifestyle factors like sexual activity and drug abuse, and CD4 count, the level of lymphocytes which determine the resistance of the body. A high CD4 count indicates 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 reaches 350 or below, prevention against common infectious illnesses is needed, which is provided in the form of regular use of anti-infective agents like bactrim, doxycycline or dapsone, in fixed doses. If the CD4 count improves later, they can be stopped. I have observed that many patients are upset if their prophylactic medicines are stopped. Any problem they get after, even just a headache or cold, they say is because they stopped taking the medication. But they should understand that these medicines are also not free from side effects.For example, long term use of bactrim can cause anemia and kidney toxicity. Medications should be taken only when absolutely necessary depending on the patient’s CD4 count. If one is in the late stages of AIDS or has a CD4 count of 200 or less, antiretroviral (ARV) therapy is started. 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 the body from developing resistance to the medication. Therefore one must take all three drugs regularly in prescribed doses and should never be stopped. On feeling better, a few people stop taking them, thinking that it is no longer necessary. These people not only are at risk of developing infections but also resistance to the drugs. Later on when drugs are resumed, they will no longer be effective. Sharing ARV drugs with friends or family is bad for everyone as nobody will be benefited in this; rather all involved can incur harm.Self-medication or taking the drugs without prescription or proper need is suicidal. When one may actually need the drugs as per the criteria, he or she may have developed resistance to the medicines. If this occurs, 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, etc. Similar to other medicines, antiretroviral drugs also cause toxicity. The most common toxic effects are gastritis, anemia, liver toxicity, and peripheral neuropathy, which causing tingling and burning pain in the extremities. Therefore if one takes medicines without proper indication he also exposes himself to these toxic effects. A word of caution here: ARV therapy does not provide one with a license to have unsafe sex. In spite of taking therapy the infected person is at risk of transmitting the disease to others. Therefore he or she should be prudent.Women should say “NO” to sex without a condom. This will protect them from HIV and 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. Breast feeding is also discouraged for the same reason. It is not only the patient’s sexual partners but also the patient’s family members who are exposed to the risk of infection, through nursing them and being exposed to their body secretions. Anyone with an abrasion or 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 disinfectant. The government of Rwanda has a well-implemented national program for HIV/AIDS compared to many other countries of the world. Now the most urgent 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. rachna212002@yahoo.co.uk
