Doctor, why did I get it? How will I face the world?
I hear the questions at least once a week. This is the stereotypical response of every HIV positive patient. They don’t even ask about treatment initially. This is because of the universal belief that HIV is fatal. Added is the social stigma associated with it.
As a care giver, my outcomes from a HIV positive patient is far better than a diabetic patient. Both are chronic diseases requiring continuous treatment and regular monitoring, and of course future complications. The fear of the disease pushes my HIV patients to take medicines which is often lacking in other chronic diseases. In this era, if a 20-year-oldHIV positive patient is started on regular HIV treatment, research say that he can survive till 67 yrs., which Is almost the normal Indian longevity. The hitch here is the regularity of medicine intake.
HIV is a viral infection that generally does not directly kill the patient. It suppresses the body’s ability to fight against infections. The patient subsequently develops overwhelming infections and finally succumbs to it. This state of profound susceptibility to infection is called AIDS. Treatment also is directed similarly.Any secondary infection is first treated, then medicines targeting HIV virus is started. In other words, if we pickup HIV infections early, before the stage of AIDS and without secondary infection, treatment can be started immediately and the outcomes are excellent.
30 yrs. back we did not have medicines targeting HIV virus. We were only treating the secondary infections due to the immunodeficiency and hence, AIDS was considered universally fatal. Then came the era of ART, Anti-Retroviral Therapy, which changed the entire course of the disease. However, these medicines act only on actively dividing viruses. HIV virus has an uncanny ability to sleep inside the nucleus (brain of a cell) of certain cells which possess a substrate called CD4. They can hibernate in this state for ever till the host is alive. That is why treatment for this infection is lifelong and we do not have a clear cut cure. However, if a patient is regular on medicines, he can practically live a normal life. Also, HIV virus can easily develop resistance to the medicines if taken irregularly. Adherence to proper ART regimen is the most important parameter for patient survival.
A major hindrance to care in this disease is the stigma associated with it. The subconscious fear of the society often inhibits care seeking behaviour. In order to address this problem, testing and treatment of HIV infection is legally maintained confidentially. The patient has to give consent for revealing any detail to other family members when he is sane and conscious. When unconscious, the issues are addressed with the next of kin. It is mandatory to inform the spouse though.
The number of HIV affected is coming down drastically thanks to the universal availability of affordable HIV medicines. Proper intake of HIV medicines limits the transfer of infection from one patient to another, including the partners and mother to child. We are shifting gradually from the era of Uncontrolled AIDS to Controlled HIV infection to probably Minimal HIV infection. Let us not look at this as a fatal problem, rather a chronic addressable disease.
Dr. Vijayalakshmi Balakrishnan
Senior Consultant, Infectious Disease and Tropical Medicine