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Face HIV, with Dr. Watiti

By Vision Reporter

Added 18th September 2011 03:00 AM

DEAR Doctor,
I was put on ARVs when my CD4 count was still high at 600 cells/ml because I was pregnant. However, in my seventh month of pregnancy, having been on the drugs for two months, I suffered a miscarriage.

DEAR Doctor,
I was put on ARVs when my CD4 count was still high at 600 cells/ml because I was pregnant. However, in my seventh month of pregnancy, having been on the drugs for two months, I suffered a miscarriage.

Must I keep taking ARVs when my CD4 count is high?

QUESTION: Dear Doctor,
I was put on ARVs when my CD4 count was still high at 600 cells/ml because I was pregnant. However, in my seventh month of pregnancy, having been on the drugs for two months, I suffered a miscarriage. This followed a malaria attack. When my CD4 count was checked after the miscarriage, it was 850 cells/ml. Do I have to continue taking ARVs?
Cissy

Dear Cissy,
ARVs, like all drugs, must be used in a rational way. Women who have a high CD4 count are put on antiretroviral therapy when they are pregnant for prevention of mother-to-child transmission of the disease and not because they need ARVs. So, after delivery of the baby or miscarriage, they must be assessed to find out whether they need to continue with the drugs or not.

Since you have a high CD4 count and do not have any serious opportunistic infections, also known as AIDS-defining illnesses such as cancer, meningitis or TB, it is not necessary to continue taking the drugs. However, you must continue using Septrin for prophylaxis and other components of the basic care package for HIV-positive people like sleeping under an insecticide-treated mosquito net, drinking clean safe water and having a balanced diet. These will help protect you from progressing into a stage of HIV where you need to take ARVs.

My CD4 count dropped by 600 cells/ml. Is this normal?

Dear Doctor,

I discovered I was HIV-positive about three years ago. I have been on Septrin since. I keep checking my CD4 count every six months. It even went up to 650 cells/ml about six months ago from the 470 cells/ml when I was started on Septrin. I was, however, shocked recently when my CD4 count dropped to 50 cells/ml. I have been advised to start taking ARVs. Is it usual for CD4 counts to drop so abruptly? Sarah

Dear Sarah,
HIV progression is usually gradual, but there is really no formula it follows. It is, therefore, important for all people who test positive to be monitored regularly like you were using CD4 counts instead of depending on clinical assessment alone. People can live with the disease for 15 years or more before their immune systems are weakened by the virus, leading to the development of AIDS. These are referred to as “slow progressors” and may sometimes be duped into thinking they were cured of the disease or they are immune to it.

Since there is such a big drop in your CD4 count so abruptly, it may be necessary to do a second test just to make sure the first one was not a mistake. If it is confirmed to be so low, you should undergo anti-retroviral therapy, adherence counselling plus having other baseline tests to check the health of your liver and kidneys.

Face HIV, with Dr. Watiti

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