Save lives: Test and treat HIV infection

Catherine Mwauyakufa, CNS Correspondent, Zimbabwe
Photo credit: CNS:
In Zimbabwe HIV-TB co-infection is a major health challenge that needs urgent resolve. Dr Owen Mugurungi, Director of the AIDS and TB Unit in the Ministry of Health and Child Care, while speaking to journalists in Kadoma, reiterated the need for TB screening for all HIV positive patients. “We encourage that all people who test positive for HIV, should get screened for TB too. There is a high probability that the people with compromised immunity also have TB, which is an opportunistic infection. We are not saying all people living with HIV (PLHIV) have TB, but the chances are 70% that they do.

Anyone with TB is also advised to get tested for HIV. However, as a country we are calling for everyone to know their HIV status. We have not reached that level. More women than men know their HIV status,” said Dr Mugurungi.

He further went on to point out that some women went into labor without knowing their HIV status. “Women visit ante natal clinics and the majority of them get counselled and tested for HIV,” he said. Dr Mugurungi said that the survival rate for people initiated on Anti Retroviral Therapy (ART) is pleasing, as it stands at 80%.“People initiated on ART during the last two years show a survival rate of 80%. For those who were initiated when the ART programme was rolled out in 2004 it stands at 70%,” he said.

Dr Mugurungi said the challenge was that most patients reported to hospitals when they were very ill and to put them on TB and HIV medication at once proved heavy on the emaciated person. “ART and TB treatment can be carried out simultaneously and at once but in most cases we first treat the TB and introduce ART once the patient is stable due to the fact that they report with a very low CD 4 cell count. If they report early on, then both treatment can run concurrently,” said Dr Mugurungi.

The largest randomized controlled study ever to see the effect of early initiation of ART, named Strategic Timing of Anti Retroviral Treatment (START), has confirmed the positive effects of early ART initiation. The study’s objective was to assess early ART initiation benefits and assess if serious health complications were averted as compared to initiation when a patient’s CD4 count fell to 350 cells/mm3.

Although in the case of Zimbabwe, statistics do not show at what stage of CD4 cell count patients, who survive today, had been initiated, deaths have been averted showing that if ART had been started earlier, the survival rate would even have been higher. Mr Stanley Takaona, an activist living with HIV for the past twenty years confirmed that before he was initiated on ART in 2004, he suffered from opportunistic infections, including TB and Kaposi’s sarcoma.

“Before I was initiated on ART in 2004, I had pulmonary TB, I suffered from skin rashes which were diagnosed to be Karposi’s sarcoma. I am pleased to say that this has since cleared, and now I am completely cured of TB and the skin cancer. If ART is initiated early enough these opportunistic infections will not be recorded,’ said Mr Takaona during a feedback meeting from the hospital visits that his team makes.The main drugs used in treating TB are isoniazid and rifampicin in Zimbabwe.

Dr Tapuwanashe Bwakura, a medical doctor at Harare Central Hospital, said that, “The majority of hospital admissions are due to HIV-TB infections. We find that 75% of hospital admissions are due to the above. We also have a serious challenge with people who stop taking TB medication after thinking that they are well. This is attributed to people’s belief in faith healing that says by your faith you are healed. So they stop taking medication with fatal results”.

“When their situation worsens due to non compliance of treatment, they go back for TB treatment but most of these patients do not admit that they had not completed their treatment earlier and so they are wrongly treated as first time patients. We find that isoniazid and rifampicin no longer work effectively and that is a challenge,” he said.

The World Health Organisation and its partners support the option of ‘Test and Treat’ for HIV, as a safe way to safeguard lives. The cocktail of ARVs radically reduces a person’s risk of transmission. As more and more people are put on medication, the epidemic should decline and a possible end to AIDS may become a reality.

It is expected that in high HIV-TB burden countries, like Zimbabwe, an earlier start of ART in people diagoned with HIV will lead to a reduction in the burden of TB, both new cases and previously treated cases. Test and treat is the way to go if we are to see an end to AIDS. With efficacious drugs for curing TB and benefits of early ART for treating HIV, the success rate in treatment and care of TB-HIV co-infection can surely record an upward trend.

Catherine Mwauyakufa, Citizen News Service - CNS
September 8, 2015