EARLY DIAGNOSIS COULD MAKE THE DIFFERENCE
Aug 16, 2009
<b>HIV/AIDS<br><br>Individuals who initiate treatment when severely unwell often have a poor outcome</b><br><br>BY IRENE NABUSOBA<br><br>MILTON Khaukha, 48, has been in hospital with full-blown AIDS for the last three weeks, but doctors fear little
HIV/AIDS
Individuals who initiate treatment when severely unwell often have a poor outcome
BY IRENE NABUSOBA
MILTON Khaukha, 48, has been in hospital with full-blown AIDS for the last three weeks, but doctors fear little can be done to prolong his life.
Lying motionless, save for the big rolling eyes in the hollow sockets embedded in what seems like a skull instead of a living head, Khaukha knows his destiny. “The doctor said they were trying their best but… (shakes his head resignedly). I should have taken that test.â€
Many people drag their feet when advised about the need to have an HIV test. Little do they know that having one’s HIV status could mean the differencebetween life and death. Recent research in Mbarara shows that many people living with HIV in Uganda are diagnosed late.
“Forty percent of the people only have their infection diagnosed when they have already developed AIDS,†researchers say in an online publication, Journal of Acquired Immune Deficiency Syndrome.
Led by Dr Isaac Kigozi, the study, “Late-Disease Stage at Presentation to an HIV Clinic in the Era of Free Antiretroviral Therapy in Sub-Saharan Africa,†covered 2311 patients who had their initial visit to the Immune Suppression Syndrome Clinic at Mbarara University Teaching Hospital between February 2007 and February 2008.
Despite the increase in talks about access to free antiretroviral therapy in sub-Saharan Africa, its success depends on early initiation of HIV care.
The study reveals that men were more likely to be diagnosed late than women (50% to 36%), as were women who were not pregnant compared to pregnant women (36% to 15%). Mandatory prevention of mother-to-child transmission programmes which enable mothers to test to help save the baby could explain this.
Late diagnosis was also more prevalent among older individuals, with over 50% of those aged between 46 and 50 being severely ill at the time their HIV was detected, compared to 35% of 16 to 25-year-olds. The researchers suggest this could be a legacy of the period when antiretroviral therapy was unavailable and there were few perceived advantages for knowledge of HIV status.
The researchers also blamed the trend on lower levels of education. Forty-three percent of the unemployed had progressed to AIDS disease at their time of diagnosis, compared to 33% of those in business.
Distance to the nearest health facility also determines how soon one goes for voluntary counselling and testing (VCT). Kigozi says 44% of those who have a journey of two or more hours diagnosed late compared to 35% of those with a journey less than 30 minutes.
The study also showed that proximity to HIV is an important factor. “Sixty-two percent of individuals with no HIV-positive household members were already severely ill compared to 39% of those with one or more members with the infection.â€
“There was also a higher rate of late diagnosis among unmarried (43%) and divorced individuals(49%)) than marrieds (35%). Surprisingly, a higher proportion of patients who reported no alcohol consumption in the previous year (42%) were diagnosed late than those who reported heavy drinking (32%),†the review notes.
Explaining to why fewer men go for testing compared to women, the programme director National AIDS Control programme, Dr Zainab Akol, says: “Men suffer with egos and stigma while women have better seeking behaviour.â€
Akol admits that access to testing services is still a challenge especially in slums, rural and hard-to-reach areas.
There are 1.1 million Ugandans infected with HIV, yet the 2004/5 sero-behavioural survey report says 80% of them do not know their status.
Akol encourages people to find out their HIV sero status to start treatment early before they get complications like karposis sarcoma and tuberculosis, which not only make treatment expensive, but also undermine recovery outcomes.
In Uganda, access to HIV treatment first became available in 1998. The treatment is free and widespread for patients who have a CD4 cell count below 200. CD4 count is a measure of the strength of the immune system. A higher CD4 count means that a person’s immunity is still strong.
“For pregnant women and children less than 12 months, the treatment can start when CD4 cell counts are above 250 but less than 350,†Akol says. “Ideally, treatment should start at the CD4 count of 350. However, due to shortage of resources, we have kept the cut-off point at 200.
Individuals who initiate antiretroviral treatment when they have a very low CD4 cell count or when severely unwell often have a poor results, yet global research suggests that between 15%-43% of individuals in resource-limited settings like Uganda are in such a situation when they start HIV treatment.
“Knowing the factors associated with late diagnosis can help in the development of programmes to overcome late start of HIV care,†Kigozi argues.
He says many research papers have indicated that universal testing and immediate treatment could theoretically stop the HIV epidemic in its tracks but has one fear: “Considering Uganda’s limited resources, this may require all the resources available for healthcare,†Kigozi says, adding that improved access to earlier testing will serve us well in the meantime as we strive for universal testing.
Individuals who initiate treatment when severely unwell often have a poor outcome
BY IRENE NABUSOBA
MILTON Khaukha, 48, has been in hospital with full-blown AIDS for the last three weeks, but doctors fear little can be done to prolong his life.
Lying motionless, save for the big rolling eyes in the hollow sockets embedded in what seems like a skull instead of a living head, Khaukha knows his destiny. “The doctor said they were trying their best but… (shakes his head resignedly). I should have taken that test.â€
Many people drag their feet when advised about the need to have an HIV test. Little do they know that having one’s HIV status could mean the differencebetween life and death. Recent research in Mbarara shows that many people living with HIV in Uganda are diagnosed late.
“Forty percent of the people only have their infection diagnosed when they have already developed AIDS,†researchers say in an online publication, Journal of Acquired Immune Deficiency Syndrome.
Led by Dr Isaac Kigozi, the study, “Late-Disease Stage at Presentation to an HIV Clinic in the Era of Free Antiretroviral Therapy in Sub-Saharan Africa,†covered 2311 patients who had their initial visit to the Immune Suppression Syndrome Clinic at Mbarara University Teaching Hospital between February 2007 and February 2008.
Despite the increase in talks about access to free antiretroviral therapy in sub-Saharan Africa, its success depends on early initiation of HIV care.
The study reveals that men were more likely to be diagnosed late than women (50% to 36%), as were women who were not pregnant compared to pregnant women (36% to 15%). Mandatory prevention of mother-to-child transmission programmes which enable mothers to test to help save the baby could explain this.
Late diagnosis was also more prevalent among older individuals, with over 50% of those aged between 46 and 50 being severely ill at the time their HIV was detected, compared to 35% of 16 to 25-year-olds. The researchers suggest this could be a legacy of the period when antiretroviral therapy was unavailable and there were few perceived advantages for knowledge of HIV status.
The researchers also blamed the trend on lower levels of education. Forty-three percent of the unemployed had progressed to AIDS disease at their time of diagnosis, compared to 33% of those in business.
Distance to the nearest health facility also determines how soon one goes for voluntary counselling and testing (VCT). Kigozi says 44% of those who have a journey of two or more hours diagnosed late compared to 35% of those with a journey less than 30 minutes.
The study also showed that proximity to HIV is an important factor. “Sixty-two percent of individuals with no HIV-positive household members were already severely ill compared to 39% of those with one or more members with the infection.â€
“There was also a higher rate of late diagnosis among unmarried (43%) and divorced individuals(49%)) than marrieds (35%). Surprisingly, a higher proportion of patients who reported no alcohol consumption in the previous year (42%) were diagnosed late than those who reported heavy drinking (32%),†the review notes.
Explaining to why fewer men go for testing compared to women, the programme director National AIDS Control programme, Dr Zainab Akol, says: “Men suffer with egos and stigma while women have better seeking behaviour.â€
Akol admits that access to testing services is still a challenge especially in slums, rural and hard-to-reach areas.
There are 1.1 million Ugandans infected with HIV, yet the 2004/5 sero-behavioural survey report says 80% of them do not know their status.
Akol encourages people to find out their HIV sero status to start treatment early before they get complications like karposis sarcoma and tuberculosis, which not only make treatment expensive, but also undermine recovery outcomes.
In Uganda, access to HIV treatment first became available in 1998. The treatment is free and widespread for patients who have a CD4 cell count below 200. CD4 count is a measure of the strength of the immune system. A higher CD4 count means that a person’s immunity is still strong.
“For pregnant women and children less than 12 months, the treatment can start when CD4 cell counts are above 250 but less than 350,†Akol says. “Ideally, treatment should start at the CD4 count of 350. However, due to shortage of resources, we have kept the cut-off point at 200.
Individuals who initiate antiretroviral treatment when they have a very low CD4 cell count or when severely unwell often have a poor results, yet global research suggests that between 15%-43% of individuals in resource-limited settings like Uganda are in such a situation when they start HIV treatment.
“Knowing the factors associated with late diagnosis can help in the development of programmes to overcome late start of HIV care,†Kigozi argues.
He says many research papers have indicated that universal testing and immediate treatment could theoretically stop the HIV epidemic in its tracks but has one fear: “Considering Uganda’s limited resources, this may require all the resources available for healthcare,†Kigozi says, adding that improved access to earlier testing will serve us well in the meantime as we strive for universal testing.