Face HIV with Dr. Watiti
Dear Doctor,
My mother has been on ARVs since 1998 and her health has deteriorated. She was on Combivir and Efavirenz for six years and her CD4 count rose from 100 cells/ml to 300 cells/ml in the first year. However, it later dropped to 53 cells/ml and she developed meningitis. She was started on second line drugs, but her CD4 count is 5 cells/ml and she is very weak. What can we do? We fear she will die if nothing is done to help her soon? Are there third line drugs she can be put on to save her life? Please advise.
Morine

Dear Morine,
WHEN people fail on both first and second line drugs, it is difficult to help them because we do not have third line drugs.

The fact that your mother improved on Combivir and Efavirenz then started to deteriorate, means she might have become complacent and her adherence became poor because she was no longer sickly. This should have been addressed before changing her to second line drugs.

ARVs work only when one takes them in the right dose as prescribed and at the right time, otherwise the virus develops resistance once the concentration levels of the drug in the blood keep fluctuating.

What could be done for your mother now is to do resistance testing if possible, to find out if there are still any ARVs the virus is sensitive to so that a possible combination can be made for her from these.

This is called salvage or rescue therapy, but still adherence must be strictly observed.

Make sure her nutrition is good and seek counselling from a qualified HIV/AIDS counsellor so that she is cared for in a holistic manner.