She has both HIV and cancer

Dec 26, 2006

DEAR doctor,<br>My mother is HIV positive but not yet on anti-retro viral treatment (ARVs). However, she recently found out that she has cancer. The doctor says that the dark nodules she has developed in her mouth are Kaposi’s sarcoma. With cancer and HIV both of which are incurable, will my moth

Face HIV with Dr. Watiti

DEAR doctor,
My mother is HIV positive but not yet on anti-retro viral treatment (ARVs). However, she recently found out that she has cancer. The doctor says that the dark nodules she has developed in her mouth are Kaposi’s sarcoma. With cancer and HIV both of which are incurable, will my mother survive for much longer? Please advise.
Lorna

Dear Lorna,

HIV kills its victims by destroying the body’s immune system, thus making it easy for diseases that would not have attacked them to do so. These are called opportunistic infections because they take advantage of one’s reduced immunity.

Normally people with HIV need to be treated with ARVs when their CD4 count falls below 200 cells per ml. CD4 count measures how strong one’s immune system is and most non-infected people have CD4 counts ranging between 500 and 1,500 cells per ml.

Sometimes, however, we start patients on ARVs even when their CD4 count is high when they develop diseases, which are referred to as AIDS defining illnesses such as Kaposi’s sarcoma.

Your mother will need to be assessed and if the Kaposi’s sarcoma is widespread she may need to be treated with anti-cancer drugs. This is referred to as chemotherapy. In some cases, HIV related Kaposi’s sarcoma resolves when patients are put on ARVs alone, but sometimes people require both chemotherapy and ARVs given together.

Your doctor will advise you on where to find this kind of treatment or you can contact doctors at the Uganda Cancer Institute in Old Mulago Hospital.

Although HIV/AIDS is incurable, people on ARVs can live a fairly long and productive life. So do not give up on your mother.

However, serious AIDS defining illnesses like Kaposi’s sarcoma usually occur in the advanced stage of HIV infection. Many of the people who start treatment late often do not benefit from it because of the advanced damage done to their immune systems.

How can we control HIV/AIDS?
Dear doctor,
I am concerned that the prevalence rate of HIV in our country has stagnated. After falling from nearly 30%, the prevalent rate is reported to have stagnated at between 6-7%. What do you think is causing this and what can we do to control the spread and eventually eradicate the disease?

Mirembe

Dear Mirembe,,/b>
It is indeed a concern that more people are being infected. This means that treatment programmes will not be able to cater for the number of people who need care.

Results of the Uganda sero-behavioural survey show that the majority of Ugandans (more than 75%) have never done an HIV test and hence do not know their HIV sero-status. This makes them engage in risky sex not knowing that they could be spreading HIV.

If all or most Ugandans knew their HIV sero-status, they would change their sexual behaviour, which would lead to a drop in HIV infections. It is sad that about 60% of new HIV infections are occurring within married relationships.

The ABC strategy, which we have adopted as a country is, in my opinion, good. But remember the prevalence rate has stagnated while we are using it. We need to look at other means of intervention. For example, there is scientific evidence that circumcision offers some protection against HIV infection. This should be encouraged as much as possible.

Emerging evidence also shows that HIV transmission by people who are on ARVs whose viral load is maximally suppressed is rare. This means that if all the people who need ARVs were to access them, the rates of new infections would also reduce further.

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