How do we help our brother adhere to ARVs?

Dear doctor, we have just realized that our brother who is sixteen and has been staying with our grandmother stopped taking his ARVs over six months ago following the death of the old woman.

The people he moved in with did not know he has to be on drugs daily because it is only our grandmother who has been caring for him since our mother died leaving him when he was only two years old.

We are now staying with him but have been wondering where to start. Should he be put on second line ARVs or can he go back on his old drugs? Ruth.

Answer

Dear Ruth, adherence to ARVs for children depends on adults but often such children have multiple caretakers and some may not know what to do.

However, although at fifteen your brother is still a minor he can be empowered so that he can with little support take charge of his adherence.

What is needed is proper counseling and disclosure, so that the boy knows he has HIV. He also needs to know the difference between HIV; an incurable disease and others diseases like malaria, which can be cured after a short course of treatment.

Concerning change of regimen from first line to second line, the doctors normally do it after establishing that the first line drugs are no longer working, which means the person takes the drugs well but the viral load keeps going up while the CD4 count keeps drops.

The patient may also deteriorate clinically. Alternatively, a test can be done to find out if the virus is still sensitive to the first like drugs or not.

This is known as resistance testing, which is expensive and not widely available in Uganda. So, the practical thing is to find out his current CD4 count plus viral load then put him back on the drugs he was taking.

 The CD4 count and viral load can then be repeated after six months to establish whether the drugs are working or not.

Answered by Dr. Stephen Watiti