Antiretroviral drugs are an essential part of HIV/AIDS treatment and should be started when the doctor who is monitoring your condition deems it necessary. Unfortunately, many of the HIV/AIDS myths in South Africa hamper proper ARV use and at times, ARV’s are started too late. In order for your doctor to notify you when ARV’s are needed, he/she will have to monitor your CD4 count and viral load over a period of time. This will ensure that you get onto ARV’s at the right time, rather than starting up later in the disease.
Rape and Needle Stick Injuries
ARV’s are sometimes started as a prophylaxis or preventative measure, especially in rape cases or needle stick injuries. The latter is common in health care professionals and if in doubt, it is better to start a one month course of ARV’s under the supervision of a doctor. Starting ARV’s immediately after an incident that could have possibly led to an infection may totally eradicate the chances of developing HIV/AIDS. Sometimes this preventative measure is considered in cases where there was unprotected consensual sex with a partner who is HIV-positive or where there is concerns about HIV infection. Always speak to your doctor in these cases and he/she will prescribe the necessary drugs.
CD4 Count and Viral Load
In South Africa, HIV-positive patients with a CD4 count of less than 200 cells/uL will be prescribed ARV’s. However in some cases your CD4 count may be much higher yet your doctor will deem ARV therapy necessary. Many patients on medical aid qualify for ARV therapy at a CD4 count of 350 cells/uL as studies have shown that starting ARV’s at this point may play a significant role in delaying the onset of AIDS and extending the lifespan of the patient. In some countries, patients with a CD4 count of 500 cells/uL qualify for ARV therapy but this is once again dependent on individual cases.
Your viral load also plays a significant role in determining when ARV therapy should be commenced. A viral load greater than 100,000 cp/ml may require ARV therapy even if your CD4 count is greater than 350 cells/uL. However this decision will be made by your doctor after consulting with you and considering the viability of starting ART (antiretroviral therapy) at this stage.
Pregnancy and Nevirapine
Pregnant women should always test for HIV infection at the earliest possible stage. HIV in pregnancy must be taken seriously as it can lead to HIV infection in your child. If you doctor is aware of your status at an early stage, he/she will prescribe the drug nevirapine, which you have to use for the course of your pregnancy. This reduces the chance of your unborn baby getting infected and reports indicate that only 5% of children born to HIV positive mothers on nevirapine will contract HIV. This is in contrast to the 30% infection rate in HIV-positive mothers who do not use nevirapine, although this figure also accounts for mother-to-child transmission via breast milk.
At times, the presence of AIDS-defining illnesses is an indication that ARV’s are needed. These diseases do not only occur in HIV/AIDS patients but they are rare in the general population. Most of these illnesses can be life-threatening and delaying the start of ARV’s can lead to death. The clinical indication for starting ARV’s may occasionally change and your doctor will keep you updated on the latest developments or changes to the therapeutic protocol.
It is important to consult with your doctor and discuss the commencement and use of ARV’s. Starting ARV’s too late can reduce your lifespan even if your CD4 counts rise and viral load drops. Fear of the side effects of ARV’s are often due to ignorance and can drastically impact on the long term prognosis of a person living with HIV/AIDS. For more information, contact your doctor or visit any private or public health facility.