Beware of advanced HIV

Dec 01, 2021

Some people living with HIV are suffering from advanced disease, but they do not know until they are attacked by tuberculosis or cryptococcal meningitis

Being enrolled on HIV treatment early prevents severe cases of HIV.

Elvis Basudde
Journalist @New Vision

The World Health Organisation (WHO) defines advanced HIV Disease (AHD) as the presence of an AIDS-defining illness.

According to the WHO website, AHD is where a person’s CD4 cell count falls to less than 200cells/cubic millimetre. However, all children younger than five years of age are considered to have advanced HIV disease regardless of CD4 count.

“CD4 cell count testing, while no longer needed to initiate treatment, remains an essential tool for identifying people with AHD. This is because people with AHD are at high risk of death, even after starting antiretroviral therapy. This risk increases with decreasing CD4 cell count.

The most common causes of severe illness and death are tuberculosis, severe bacterial infections and cryptococcal meningitis,” the WHO site explains.

Some people living with HIV are suffering from advanced disease, but they do not know until they are attacked by tuberculosis (TB) or cryptococcal meningitis. When a person gets one of these illnesses, he or she is diagnosed with the advanced stage of HIV infection, known as AIDS.

There are over 1.3 million people living with HIV in Uganda and about 22,000 died of AIDS-related illness in 2019. This means 60 people per day and 421 per week. Most of these deaths are because of advanced HIV disease, half are due to TB and cryptococcal meningitis, according to UNAIDS.

Others are cervical cancer, coccidioidomycosis, encephalopathy, herpes simplex, Kaposi sarcoma, lymphoma, pneumonia, toxoplasmosis of brain and wasting syndrome due to HIV.

Monitoring your health

To determine one’s HIV disease status, a test is carried out to find out one’s CD4 cell count. CD4 cells are white blood cells that fight infections.

They are like a snapshot of how well your immune system is functioning. Usually, the CD4 cell count increases when HIV is controlled with effective treatment.

Dr Steven Watiti, a person living with HIV and also an activist, says the only way to know if you have advanced HIV disease is to get tested. Many of the severe symptoms and illnesses of HIV disease come from the opportunistic infections that occur because the immune system has been damaged.

Activists say despite progress in tackling the HIV epidemic, many people start anti-retroviral therapy late when advanced HIV disease has attacked the body and weakened their immune system. There is a high risk of disability caused by opportunistic illnesses.

Richard Serunkuuma, the executive director of Positive Men’s Union (POMU), says in spite of the ARVs, there is still a lot to be done.

Dr Abdullah Nkoyooyo from the Infectious Diseases Institute says HIV is not a disease one should be ashamed of. The most important thing is to get tested and if the result is positive, you start the medication early and take it regularly,” he explains.

Dr Watiti advises that people living with HIV get a CD4 test every three to six months, or as often as their doctor recommends, to see how well their immune system is doing.

HIV treatment is recommended for everyone who has HIV, but it is especially important for people with a low CD4 count.

With these two diseases, it is best that you get treatment before you start to feel sick, because this can prevent the dangerous illness and death. Watiti says HIV is a manageable condition. When the medications for HIV are taken regularly, people living with the virus can lead productive, healthy lives and can live just as long as people without HIV.

While HIV cannot yet be cured and one has to take medication for life, the disease is no longer a death sentence. With adherence to medication, the virus can become undetectable in your blood.

And when the virus is not detectable in your blood, it would be impossible for you to spread HIV to other people.

This is known as U=U, meaning “Undetectable=Untransimissable,” Dr Watiti explains.

Why advance to disease?

Watiti says sometimes, when HIV is not detected early enough, or when the medications are not taken properly taken, serious illnesses can still happen.

The most opportunistic infections are diseases of lungs, skin, intestines or brain. And many can be deadly.

Unfortunately, many people do not know they have HIV until they get one of these infections, which is why regular HIV testing is important.

The two infections that are most common are TB and cryptococcus meningitis, an infection of the covering of the brain. People with TB usually have cough, lose weight and sweat a lot at night, while people with meningitis will have headaches, stiff neck, confusion and are sensitive to light.

“If you find out you have advanced HIV because of your low DC4 count, you can get medications that will prevent these infections from happening, called prophylaxis.

Fortunately, the infections common in advanced HIV disease also have better treatment than before, according to Watiti.

Health experts advise that it is still much treated before it becomes advanced, adding if you go to a hospital anywhere in Uganda, good treatment for advanced HIV infections is increasingly available, at no cost.

The right treatment

Just like the medications for HIV, you must be sure to take medications for cryptococcosis or TB daily, as prescribed.

One of the important ways of treating meningitis is with a procedure called a lumber puncture. These are necessary to help drain some of the extra fluid that builds up around your spine and brain and also allows the disease to be diagnosed.

Lumber punctures are safe and in many cases prevent people from dying from meningitis, Watiti says.

However, many clinics still do not have the testing supplies and medications that are necessary to treat HIV and prevent advanced HIV. Activists say they want to ensure that people living with HIV do not die of advanced HIV disease, though they regret that in Uganda, HIV is still a subject of serious misconception, ignorance and fear.

They say HIV can be spread by sharing needles, sex or through childbirth. The virus works by weakening one’s immune system so that other infections and illnesses can take hold and do harm, and has sadly cost far too many lives.

There is an urgent need to present facts about HIV simply, to reduce the fear, stigma and discrimination associated with HIV and to provide practical advice on how to minimise the risk of contracting or transmitting the infection, as well as how to provide care and support to infected and affected people, they say.

In a way of mitigating advanced HIV disease, they say in addition to regular testing and adhering to treatment, there are other steps one could take to avoid advanced HIV disease. For example, you are advised to spare your body from stress, because it can weaken your immune system and make you more vulnerable to illness and infection. You should also get vaccinated, practise safe sex, eat nutritious food and take care of your body by doing exercises.

“We have the tools — testing and medication to make sure that there are no more needless deaths, so let us get out there and spread the word so that advanced HIV disease becomes a thing of the past,” Watiti says.

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