I have HIV and pressure, what can I do?

Question 24

November 24, 2017

I have HIV and pressure, what can I do?

Dear doctor, I am HIV positive and have been on ARVs for the last ten years.

I am doing well; my CD4 count has always been high and my viral load is undetectable. I am really grateful to God that ARVs have given me a new lease of life because when I was started on ARVs, I had AIDS.

My challenge now is that I have developed high blood pressure and the drugs I need to treat it are very expensive! Unlike ARVs that are given free at my clinic, I have to buy them myself.

I often miss taking them and though I do not feel anything the doctors have warned me that the pressure could damage my kidneys. 

What do I do now because the truth is that I cannot afford buying those expensive drugs, which I have to take daily the way I do ARVs? Nelson.

Answer

Dear Nelson, what you describe here is the experience of many people living with HIV (PLHIV), whose lives have been saved by ARVs. Because of the opportunity to live longer, sometimes coupled with unhealthy lifestyles plus side effects of some ARVs; many PLHIV are being plagued by what are known as non-communicable diseases (NCDs).

These include: high blood pressure, cancer, diabetes and psychiatric conditions such as depression and psychosis associated with HIV. Unfortunately, most antiretroviral therapy (ART) programmes that give free ARVs, do not have budgets for treating these diseases, all of which as you have noticed are very expensive to treat.

Unfortunately, as you have been told even if you have a high CD4 count and you viral load is undetectable; high blood pressure if left untreated will affect your health adversely. So, our advocacy efforts must now broaden beyond advocating for availability of ARVs for all who need them.

We have done very well in this area and now over one million Ugandans are on ART. We must advocate for improved and sustainable health for all. This includes prevention and treatment of NCDs like diabetes, cancer and high blood pressure. However, for your case, you may have to get a few people who know you well; people who saw you dying of AIDS but now they see you are "doing well" and share with them your current problem.

Many of them who see you looking healthy may not know you are in danger of death if you continue living with poorly controlled high blood pressure.

This is called disclosure, which many of us PLHIV have used to galvanize support that has helped us to not only access expensive treatment like ART but also psycho-social support needed when living with incurable diseases like HIV, many cancers and high blood pressure.

Question 23

I cannot leave alcohol, yet I feel bad after taking ARVs

Dear doctor, I am a 22-year-old sex worker. Unfortunately, I recently discovered I am HIV positive when one of my regular clients insisted we go for an HIV test because he wanted to marry me.

He was still negative. I was immediately started on ARVs but two months into the treatment, I am not coping well. I feel so weak and drowsy most of the time and so for some days I have to skip taking the drugs or change and take them during day if I have to go out at night to work; otherwise we would have no food or money for rent.

I also get terrible dreams when I go sleep. It is even worse when I swallow them and take some alcohol, which I often do considering the nature of my work. What can be done to help me? Janet.

Answer

Dear Janet, it is unfortunate that maybe because of the environment at the clinic you attend or fear of being blamed and discriminated against because of being a sex worker you did not open up to your doctor concerning what you do for a living. 

He could have put you on a user-friendly regimen instead of the one you are on that most likely contains Efavirenz. Efavirenz though a good drug, has those effects of causing drowsiness on top of bringing nightmares to some people.

That is why it is advisable that you take it at night when going to sleep. Ideally, every patient or client should be treated differently after through history taking, clinical examination and laboratory investigation, so that proper advice and counsel are given.

This was not done for you. Differentiated service delivery is necessary in HIV and AIDS care because the "one size fits all" model, which we often use clearly does not work for all.

No wonder many are failing on regimens that are helping others. What you need is to open up to your doctor concerning the work you do and the challenges you are encountering with the ARVs you are on.

What would actually work for you is to substitute Efavirenz with another drug like Nevirapine, if it is not contraindicate or Dolutegravir if it is available.




Question 22


Don't all ARVs work in the same way?

Dear doctor,
I have been on ARVs for over three years. I usually take one tablet once at night. Apart from causing drowsiness soon after taking them and making me sleepy, there has actually been no other serious bad effect I have felt while on them. Recently, I went to visit my sister and delayed to come back and so my drugs ran out. However, my sister whom I did not know was also taking ARVs gave a bottle of hers but there were sixty tablets instead of the usual thirty that I take. So, I have been taking one tablet of these daily but realized they are not as strong as mine because they didn't make me feel dizzy. When I went back to my clinic for review, I was told that my drugs had been changed. What I wanted to know is whether to continue with the new ones, which do not make drowsy or  go back to the old ones. Don't all these drugs work in the same way? Dorothy.

Answer

Dear Dorothy,
It is true that ARVs work in a similar way by blocking the multiplication of HIV in the body. However, they are different and that is why they are formulated differently with some taken twelve hourly while others are taken every twenty-four hours. For example, your original drugs most likely consisted of: Tenofovir, Lamivudine and Efavirenz; which have been put together in one tablet that you take once at night. On the other hand the ones your sister gave you most likely consisted of: Zidovudine, Lamivudine and Nevirapine put in one tablet that is taken twelve hourly. So, as you can see they are different except for Lamivudine, which is found in both formulations. MY advice is that you go back to your original regimen because in any case you have been taking half dose of the ones your sister gave you, which are supposed to be taken twice a day. This is very bad! Secondly, try to learn the real names of the drugs you are on. They are usually three different names written on the bottle; instead of just describing them by colour and/or shape because; even though they are all ARVs, they are different. This is treatment literacy and it is very important for anyone who is on antiretroviral therapy, which is treatment for life.