I started taking ARVs before a CD4 count
Feb 03, 2008
DEAR Rachel, it is a pity that you were started on ARVs in an irregular manner just because your sister could access them. Ideally, one should start taking ARVs after doing a CD4 count to measure the amount of damage done to the immune system by HIV.
Dear doctor, I am HIV-positive and have known this since 1998. When I was pregnant last year, my sister, a medical person based abroad, sent me ARVs and I started swallowing them even though I did not know my CD4 count. I was put on Zidovudine, Lamivudine and Nevirapine. These, however, run out after delivery. My sister advised me to give my baby Zidovudine and Lamivudine for six weeks after birth to prevent mother-to-child transmission. The child is now six months and looks healthy. Recently, I went for a CD4 count and found it to be 300 cells/ml. Currently, I am not on any treatment, but feel okay though I am worried and do not know how to proceed. Please help.
Rachel.
DEAR Rachel, it is a pity that you were started on ARVs in an irregular manner just because your sister could access them. Ideally, one should start taking ARVs after doing a CD4 count to measure the amount of damage done to the immune system by HIV.
It is difficult to know now whether you were eligible at the time you started taking these drugs or not. It is possible your sister wanted to prevent mother-to-child transmission, but even in regard to this, it should have been done in a rational manner by measuring your CD4 count and if possible the viral load before starting.
The other issue you raise which we must consider before starting antiretroviral therapy is whether the treatment can be sustained with a regular and reliable supply of ARVs.
If sustainability is not guaranteed, it is better not to start to avoid developing drug resistance.
Currently, it is important that you undergo all the baseline tests like the liver and kidney function tests. If these are normal, you should go back to ART since the high CD4 count now may be because you have been on ARVs.
You should also register with a credible HIV/AIDS service organisation such as The Mildmay Centre, JCRC, IDC or TASO to ensure professional care and monitoring.
You should also find out the sero-status of the baby using the PCR method since the antibody test may be positive because of the maternal antibodies the baby got from you at birth. The antibody test can only be reliable after the child has reached 18 months.
Lastly, it is important that you disclose your status to your sexual partner so that if he is not yet tested, he does so and if he is positive, he accesses care early enough to avoid developing serious opportunistic infections.
Send your question on HIV to Health Editor, The New Vision. P. O. Box 9815, Kampala orhealth&beauty@ newvision.co.ug
Rachel.
DEAR Rachel, it is a pity that you were started on ARVs in an irregular manner just because your sister could access them. Ideally, one should start taking ARVs after doing a CD4 count to measure the amount of damage done to the immune system by HIV.
It is difficult to know now whether you were eligible at the time you started taking these drugs or not. It is possible your sister wanted to prevent mother-to-child transmission, but even in regard to this, it should have been done in a rational manner by measuring your CD4 count and if possible the viral load before starting.
The other issue you raise which we must consider before starting antiretroviral therapy is whether the treatment can be sustained with a regular and reliable supply of ARVs.
If sustainability is not guaranteed, it is better not to start to avoid developing drug resistance.
Currently, it is important that you undergo all the baseline tests like the liver and kidney function tests. If these are normal, you should go back to ART since the high CD4 count now may be because you have been on ARVs.
You should also register with a credible HIV/AIDS service organisation such as The Mildmay Centre, JCRC, IDC or TASO to ensure professional care and monitoring.
You should also find out the sero-status of the baby using the PCR method since the antibody test may be positive because of the maternal antibodies the baby got from you at birth. The antibody test can only be reliable after the child has reached 18 months.
Lastly, it is important that you disclose your status to your sexual partner so that if he is not yet tested, he does so and if he is positive, he accesses care early enough to avoid developing serious opportunistic infections.
Send your question on HIV to Health Editor, The New Vision. P. O. Box 9815, Kampala orhealth&beauty@ newvision.co.ug