Dear doctor, my brother had TB in January and also tested HIV-positive. His CD4 count was 230 cells/ml. He was treated for TB and improved. When his CD4 count was checked in June, it had gone up to 350 cells/ml and doctors said he did not need ARVs. However, recently he developed meningitis. What should we do now because he is sick and confused?
Alex

Dear Alex,
Developing TB when HIV-positive could mean someone’s immune system is damaged. Your brother should have been started on ARVs even when his CD4 count had gone up.

Both TB and meningitis are called AIDS-defining illnesses, which occur in the late stages of the disease and patients who develop them should be put on ARVs even if their CD4 counts are high. It is also possible that your brother’s viral load, a measure of how active the virus is in the body, is high.

Treating HIV is like repairing a tear in a cloth; we should never wait until the tear is impossible to fix. The cut off point for starting anti-retroviral therapy is when one’s CD4 count drops to 250 cells/ml or below but this is just a guideline for poor countries.

Generally, people who start taking their ARVs early, tend to do better than those who start late when their immune system is already badly damaged. Your brother should be treated for meningitis and ART should be initiated regardless of the CD4 count.


Should I continue with my medication?
Dear doctor, I have been on ARVs (Combivir and Alluvia) for over two years. Recently, I went abroad, ran out of ARVs and was given Triomune at a local pharmacy. I have been on it for two months and feel okay. Can I continue with this drug or do I go back to my old regimen?
Ezra.

Dear Ezra,
Adherence to one’s regimen of ARVs is important if the therapy is to be successful. If you keep missing doses or changing regimens, you might end up with drug failure. At first you may not feel unwell but as time goes on you will start to develop opportunistic infections.

Though Combivir, Alluvia and Triomune are all ARVs, Triomune is a first line regimen while Combivir and Alluvia are usually used when one fails on a first line regimen. You should go back to your doctor who should check your CD4 count and viral load before putting you back on your second-line regimen.

You should avoid journeys which will make you fail to adhere to your treatment and force you to buy ARVs from untrained people.

My brother was treated for TB, now has meningitis