HIV/AIDS: A Hidden Time Bomb

Chronic Conditions

HIV/AIDS, over the last decade, has recently not been labeled as the devastating illness as it was labeled some 20 or more odd years back; relative specifically to the Western world and the African continent.

The Western World introduced HIV/AIDS treatment and prevention programs that were largely effective and therefore managed to curb the epidemic to almost nipping it in the bud (the emergence of new cases was successfully curbed). Having worked as ‘Incharge Physician’  at one of the busiest hospitals of Punjab, and facilitator for the Govt under the umbrella of WHO and its sister organizations will try to give a perspective of the disease which is especially relevant to us.

With the prevailing stigma and misconceptions, the booming epidemic in Pakistan prompts further that the public is made aware about the disease while the Govt along with international agencies work to curb the spread of the disease here.

I will briefly go about the basic data about the epidemic and then go to the national situation after talking a little about the ‘Whats and Whys’ of the disease.

As of 2015, there are 36.7 million people living with HIV/AIDS globally with the newly infected being 2.1 million in 2015 as compared to 3.4 million in 2001 which is a 38 % decline.1 The access of people living with HIV (PLHIV) has improved significantly over the last 2 decades, reflecting in the reduction of deaths due to HIV&AIDS to 1.1 million, 45% fewer than in 2005. As of 2015, 46% of all the PLHIV are on Anti-retro-viral therapy (ART)2, which is the reason for the decline in new cases and the brakes applied to the epidemic especially in those parts of the world which were considered hot spots for the disease.

Local Perspective Of HIV/AIDS:

After the first case reported in Pakistan, way back in 1986, Pakistan has come a long way in setting up a National and eventually Provincial AIDS Control Programs. Currently, 0.1% people of the total population are estimated to be living with HIV out of which 17,224 are registered at the different clinics across Pakistan. Almost 47% of these people are on ART3 which is almost the same as the international figure for PLHIV on ART (which is the best way to eventually control its progress and eventually its spread).

However, we are still in a state of a concentrated epidemic which means that the prevalence is greater than 5% in high-risk groups (IV drug abusers {IDU’S} etc). There are different cities across the country which have more IDU’s and other high-risk groups like commercial sex workers, repatriated migrant workers, males who have sex with men (MSM). Without pointing out a particular city it goes to show that there are different density pockets of high-risk groups throughout different cities which are obviously subject to interventions to reduce the disease spread and burden.

So, let’s focus on what is HIV&AIDS and how can it be treated?

HIV:

Trying to keep this simple is like asking someone fit titanic into a bottle.

To start, HIV is a virus which actually is pretty clever at replicating itself inside the human cells and can make its nuclear material (RNA) from the DNA in the human cell by reverse engineering which is why its called a ‘Retrovirus’ (normally DNA is used to make RNA in cells).

The HIV virus principally acts on the immune cells of our bodies, specifically CD4 cells. The CD4 cells basically act as a central police station which controls the small police units in the city or locality. When the Police station goes down, the city goes down. Make sense? This is how devastating this virus and its effects can be on the human body. It can take years and years for the disease to take effect (it works silently). And manifests itself only when most of the immune system is gone or taken down.

Where it originally came from?

Practically speaking its been around for ages, but probably not in our species. The first few cases which were ‘officially’ recognized were in the early 80’s however unofficially there have been cases similar to the typical cases of HIV/AIDS in people coming from Africa to the western world for the last 50-60 years.

It has been theorized that this virus made a species jump from the chimps (where it was not causing any disease) to the humans where it mutated and started causing the disease which have come to know of.

AIDS:

It is short for Acquired immunodeficiency syndrome. Which actually means, a disease which is due to weakening of the immune system and gives rise to a whole host of diseases ( which is why a ‘Syndrome’).

The spread is very important to know about as most of the stigmatization which the PLHIV come across is because the people around them are not aware of the disease spread and prevailing misconceptions due to many reasons.

1. It is a blood borne disease:

It is spread through blood contact as in contaminated blood transfusion, IV drug abuse, use of unsterilized instruments in procedures( minor or major) from dentistry to major surgeries, or coming into contact with the blood of a person infected with HIV while your own blood is exposed as in mucosal injuries ( open wounds, eczema of the skin etc, exposure to a needle or sharp which has HIV infected blood on It)

2. Sexual contact:

Where one is already infected. Be it male with female or male with male.

3. From an infected mother to her child during the ante-natal period and during birth.

There is treatment for HIV & AIDS and it is available in Pakistan under the umbrella of the Provincial/National AIDS control programs at different HIV/AIDS treatment centers with collaboration of Global Fund and other international agencies.

There are different outreach programs working on education, screening and risk/harm reduction in high risk groups as a partnership of Govt.with NGOs. And the best thing is, that the treatment, along with the diagnostics are all free. So if you hear about someone being diagnosed with HIV or is being suspected of HIV/AIDS kindly refer him to a HIV/AIDS treatment center near them (link for the network of HIV/AIDS treatment centers being shared below).

Not to neglect is the psychosocial impact of this grim disease.

IT can break families, ruin relationships and breakdown the most sane. Keeping this in regard, special emphasis is given to counseling and psychosocial rehab of this these patients and also their families, the latter being the ones who can actually help the most in bringing the patient from darkness into the light. Regular counseling sessions are provided to affected families and patients at the centers by Professionals.

The crux of the treatment strategy for HIV/AIDS is to use the medications regularly without hiatus.

The gaps in treatment can render the development of resistance in the virus and make it powerful against the current treatment regimens. The good news is that if taken regularly as advised these patients can live normal lives like anyone else in the society and be productive in every facet of their lives. Extrapolation of life expectancy of patients with HIV/AIDS on treatment show that the life expectancy goes up by a whopping 50 years!

The way these patients climb out of the abysmal infectious states to being perfectly normal clinically is just a wonder to behold.

I have been witness to these miraculous recoveries first hand, managing these patients. Such patients can marry, yes, and can even marry non- HIV +ve people and follwoup with their treating Physicians and Counselors. And with proper guidance, their spouses can remain –ve and they can have perfectly normal HIV –ve babies like anyone else.( all being subject to the patient being completely adherent to treatment).

Unfortunately we are yet to find a cure for HIV/AIDS, as the current regimens do suppress the virus but do not totally eradicate it (has to be taken life long). And vaccine trials till now have not proved to be effective as the virus is really difficult to target due to its changing morphology (much like the hepatitis C virus, as both are of the same family!).

1. It is not spread by casual physical contact (hand shaking, hugging, kissing, sitting and eating together).

2. It is not spread by eating in the same plates and using same cutlery.

3. It is not spread by contact of blood of an infected person on your skin when its not damaged.

4. Yes, proper barrier nursing (masks and gloves, isolation ) is required in patients with suspected Smear +ve Pulmonary Tb but not with every other HIV patient.

5. The HIV +ve patients can marry or have children as it has been already clarified this point in the section of ‘Treatment/Cure’.

1. Going for the dentist, barber, ear/nose piercings, kindly insist on proper sterilization of instruments. It’s your right!

2. Avoid getting tattoos.

3. Abstain from promiscuous sexual activity.

4. Avoid getting/insisting on IV injections for common ailments (which is very common in our setup).

5. Only get blood (or blood product transfusions) when your authorized Physician advises you. Avoid insistence on unnecessary blood transfusions.

6. Stay away from drug abuse!

7. Please don’t stigmatize anyone with this disease, its just a disease like any other, like Hepatitis B or C (spread by the same routes). This disease wrecks havoc on the mental states of the affected. Emotional/psychological trauma is an aspect of this disease. The best we can do is by not judging and by being empathic and supportive. Love and care can do wonders to people who actually recover from this illness, as without it, giving treatment is just like dragging a tired horse.

8. Spread the word about what you now know!

There Is Hope For HIV/AIDS Patients!

Although we along with many other developing countries are now in the earlier part of the epidemic and going through what may be the developed countries went through 30 years ago. WHO along with the National programs have implemented a really aggressive strategy of bringing the undiagnosed patients into the net of treatment and putting them on treatment which actually serves as prevention.

Our National/Provincial programs are headed in the right direction, with proper awareness & education of the masses/healthcare providers, we can together stand against this menace which threatens to hit us hard. There is Hope!

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Dr. Syed Hunain Riaz

Dr. Syed Hunain Riaz

He is a Specialist Physician by qualification with expertise, interest and experience in Endocrinology/Metabolism and infectious diseases. He has extensive experience in delivering talks to audiences regarding topics relating to Endocrinology/Metabolism and HIV & AIDS( on platforms of various international organizations). Has a few research articles under his belt. He likes to convey his thoughts through articles for the masses. Besides medicine has interests in astronomy/cosmology, traveling, photography and philosophy.

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