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| Sunday, 1 December 2002 |
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| News Business Features Editorial
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Compiled by Carol Aloysius Today is World AIDS Day : The devastating effects of ...HIV/AIDS We dedicate this page to all patients suffering from this fatal disease, in the hope that by raising more awareness about HIV/AIDS we can help towards overcoming the stigma and prejudice that prevent such patients from getting the care they need and enjoying their rights as human beings. What is AIDS AIDS is a disease caused by a virus which can breakdown the body's immune system and can lead to fatal infections and some forms of cancer. AIDS - Stands for Acquired Immune Deficiency Syndrome HIV - Stands for Human Immunodeficiency Virus, the virus which causes the disease. HIV infection - means infection with AIDS virus or AIDS virus infection. When the AIDS virus enters a person's body, it penetrates certain cells in the body where it can remain for the life of the person. In some people who are infected, the virus remains quiet for years before it causes AIDS. These people may look and feel healthy. However, they may spread the virus to sexual partners during this period. They could infect others through donation of their blood. In others the virus becomes very active, multiplies rapidly, spreads through the body and causes AIDS quickly. This may happen a few months or several years after the virus has infected them. The virus causes AIDS in the following way. It disables or destroys certain kinds of cells which normally help the body to fight disease. As a result, the body cannot defend itself against infections and certain cancers. These patients are then susceptible to infections and cancers - diseases which a healthy person could resist. AIDS is the most severe kind of illness caused by the AIDS virus HIV. But, other illness also result from infection with the virus and usually get worse with time and develop into AIDs. The Virus and the Immune System HIV - The virus that causes AIDS belongs to a class of viruses called retroviruses. Like all viruses the (HIV) virus reproduces only in living cells. Once the virus enters a host cell, permanent infection is established. There are many different strains of HIV. Some vary only slightly from one another, while others vary extensively. Most strains differ in the outer viral coat, or envelop, which is the first part of the virus recognised by the immune system. The HIV virus appears to have the ability to change the genetic structure of its outer coast rapidly, and thereby escape recognition by the immune system. This makes development of a vaccine difficult. The immune deficiency in AIDS stems largely from the gradual depletion of a specialised group of white blood cells called T-Helper or T-4 cells, which plays a key role in regulating the immune response. HIV selectively infects T-helper cells as well as several other types of cells in the immune system. The virus multiplies in the T-helper cells and destroys them. The destruction of large numbers of T-helper cells, is partly responsible for the immune deficiency. There are as yet many other factors not fully understood which could account for the disastrous effects on the immune system. **** Symptoms Infection with HIV (Virus) takes many forms. It ranges from a complete absence of symptoms, to mild illness to debilitating neurological disorders and fatal diseases. AIDS is the end stage of the infection. Many people infected with the virus have no symptoms, and do not know that they are carrying the virus as they appear healthy and feel well. HIV infection can be subdivided into five stages: i. Acute illness ii. Latency phase iii. Stage of Persistent Generalised Lymphadenopathy iv. AIDs Related Complex (ARC) v. AIDS. Acute illness: The acute phase may occur 2-12 weeks after infection. Antibodies to the virus appear in the blood 6-12 weeks after infection, but may take as long as 6-8 months or more. Some of the clinical manifestations are: fever, rash, sore throat, headache, night sweating,cough and some times enlargement of lymph nodes. Often these features subside after about 2 weeks or a little longer. The Latency Phase: This phase is characterised by an absence of illness. The infected individual shows no external signs of disease. Stage of Persistent Generalised Lymphadenopathy (PGL) An infected individual has reached this stage when lymph nodes larger than 1 cm, in diameter are found in two or more sites other than the groin, for periods of at least three months duration, - in the absence of any other illness. Lymphadenopathy is one of the most common signs of HIV infection. Common AIDs related opportunistic infections Most AIDS patients develop multiple opportunistic infections or cancers and die, either because: 1. The infection cannot be treated effectively or their weakened immune system impairs resistance to infection and response to therapy. The following are the most common opportunistic infections: Kaposis Sarcoma Is common in homosexual men who develop AIDS. Kaposis Sarcoma appear as dark blue or purple raised areas on the skin, often first appearing on the trunk or upper extremities, but also on the ears and nose. The skin nodules are not itching and painful. The disease commonly spreads to the internal organs. Tuberculosis TB can affect many organs. In AIDS patients tuberculous leisions may be found in sites not usually affected by the disease. Herpes Simplex Herpes simplex viruses caused skin leisions in or around the mouth or in the genital and rectal areas. In patients suffering from AIDS these leisions are severe and recur more often than in non-AIDS patients, and tend to be disseminated to other parts of the body. Candidiasis or thrush is caused by a yeast. Two types occur in AIDS patients. Oral Candidiasis causes white usually painless leisions in the mouth. Courtesy Health Education Bureau **** AIDS HotLine The NSACP (National STD/AIDS Control Program) has started a HotLine service at the central STD clinic. Information and Counselling on sexually transmitted diseases and HIV/AIDS provided by medical officers would be available to the public on this line 667162. These services are available from 9 a.m. - 3 p.m. on weekdays and from 9 a.m. - 12 noon on Saturdays. STD/AIDS Newsletter The NSA-CP has begun publishing a regular newsletter to update readers on the current STD/HIV/AIDS situation in Sri Lanka, as well as information on recent developments in the field. The newsletter is available to the public at the central STD/AIDS control office in Colombo. A feedback from the readers is welcome, say the editors. *****
Counselling can make a difference by Dr. K. Senanayake (Consultant Venereologist NSACP) HIV/AIDS has made a significant impact on the world community. The situation has reached epidemic proportions and poses a major health problem in developing countries including Sri Lanka. Until now a successful vaccine or a drug, which prevents the infection through an exposure to the virus or cures the disease, has not been found. However a significant break-through has occurred in providing antiretroviral therapy (ARV) where definite clinical benefits have been achieved prolonging the lifespan and improving the quality of the life of these patients. In the present context health educational strategies including counselling is vital in the prevention and care of this dreaded disease. The main mode of transmission is sexual, accounting for more than 80% of the spread of disease. Therefore, behaviour change becomes the cornerstone for modifying the course of this infection in terms of prevention. Behaviour change is not an easy process and it may take a considerable period of time to achieve a significant positive result. In the process they will undergo an internalization of the positive attitude when the person becomes dissatisfied with the present behaviour and tries to adopt a better behaviour. The consequences of the behaviour change influence not only the person at risk or person infected but also his or her sexual partners. The major strategy for the accomplishment of this task is through education, where the tool applicable is information, education, and communication (IEC) where large numbers of persons are exposed to information through mass media or in-depth education giving more technical details of a subject. These methods are successful in achieving the desired behaviour change in certain sections of the society whereas for some other groups personalized or tailor-made strategies which address the psychological needs of the groups in addition to the educational inputs are required. This approach is known as counselling where certain principles and concepts are applicable, and certain skills have to be developed by the counsellor. Maintaining confidentiality of each and every person during counselling is very important. Among the skills the counsellors have to develop are a non-judgmental attitude, empathy, listening, and accepting what the client says. After a session or more with the counsellor the client is made to grow and develop a mental state where insight into the problem is developed and the client can take his/her own decision. With counselling, the clients are exposed to general information about the disease in the context of IEC. Through the service providers in counselling and IEC the public receive knowledge about HIV/AIDS and change attitudes and behaviour, resulting in not acquiring HIV/AIDS. In addition providing services through targeted interventions, the populations at risk: sex workers, foreign employment seekers, and STD clinic attendees, receive information about safer sexual behaviour, condom use, voluntary counselling and testing (VCT), and other services. Counselling provides valuable service for HIV/AIDS patients in the form of psychological support and referrals to clinicians, and provides information about NGOs who provide care for these patients. Counselling is a time consuming process and the service provider has to develop some qualities, which are inherent in being an effective counsellor. AIDS update **** Lab facilities for Lankans with HIV and STDs Dr. S.M. Mananwatte, Consultant Microbiologist Laboratory investigations are essential to confirm the diagnosis, monitor the progression of and evaluate the response to treatment in HIV infection and other sexually transmitted infections (STIs). HIV infection The standard test for diagnosis of HIV infection is serology for antibody detection. Two main groups of antibody detection tests are performed at the Central Reference Laboratory of the National STD/AIDS Control Program (NSACP). 1. Screening tests 2. A confirmatory test The screening tests are carried out by using three different techniques: I. Enzyme Linked Immune Sorbent Assay (ELISA) II. Particle Agglutination test (PAT), III. HIV Spot test (Rapid test) The HIV Spot test is used in specific occasions such as time limited situations when a rapid result is required. A confirmatory test is carried out when the screening test is positive. The confirmatory test that is performed at the Central Reference Laboratory is the Western Blot. Laboratory tests are also performed to identify HIV related opportunistic infections. Some of the opportunistic infections found in Sri Lanka are oesophageal and bronchial candidiasis, tuberculosis, salmonella infections, cytomegalovirus infection, pneumocystis carini infection and toxoplasmosis. In addition the reference laboratory provides diagnostic facilities for other STIs including syphilis, gonorrhoea, chalamydia infection, candidiasis, trichomoniasis, bacterial vagnosis, genital herpes, hepatitis, B and C infection. ***** Early breastfeeding reduces HIV risk Recently published studies from Sub-Saharan Africa suggest that early weaning could reduce some, but not all mother-to-child transmission of HIV through breastfeeding. They also suggest that combining breastfeeding with formula-feeding may carry a higher risk of "vertical" transmission, than exclusive breastfeeding. Drug to prevent mother to child transmission of HIV Preliminary results of a study conducted in Uganda showed that a potent and long-lasting drug, nevirapine was 47 per cent more effective in reducing mother-to-child transmission of HIV. At about US$4 the cost of the two doses of nevirapine used in the study is a fraction of the cost of other antiretroviral regimens. ***** Antiretroviral therapy (HAART) for Lankan HIV/AIDS infected patients? The Dept. of Health has initiated action and convened a consultative workshop to explore the possibility of providing antiretroviral therapy to HIV/AIDS patients in Sri Lanka. If the Department is able to procure these drugs now available mostly in developed countries due to their prohibitive costs, and provide therapy to HIV/AIDS patients, their quality of life can be improved dramatically. Their lives can also be prolonged, says Dr. Kulasiri Buddhakorala, Consultant Venereologist at the NSACP... In 1996, when highly active antiretroviral therapy (HAART) was introduced to the market, the average cost for the three-drug regimen per person per year was US$12,000-20,000. After the introduction of several brand names and several types of drugs the cost has come down to US$8,000-12,000. Towards the end of 90s and at the beginning of year 2000, the Indian pharmaceutical industry started manufacturing of generics of these drugs. The event revolutionized the access to antiretroviral therapy (ART) in resource poor settings. The Indian pharmaceutical companies offer antiretrovirals (ARV) at a cost of US$350 per person per year. The Department of Health and Human Services (DHHS) in the USA has published guidelines for the use of ARV agents in HIV-infected adults and adolescents. This report recommends that care should be supervised by an expert and makes recommendations for laboratory monitoring including plasma HIV RNA, CD4 cell counts and HIV drug resistance testing. It recommends treatment for all patients with acute HIV syndrome, those within six months of HIV seroconversion, and all patients with symptoms ascribed to HIV infection. While the majority of people living with HIV/AIDS (PLHAs) in rich countries is receiving HAART, based on an individualized clinical approach, only an estimated 150,000 PLHAs in developing countries are receiving ARVs one way or another. This is due to the high cost of the antiretrovirals. The situation is aggravated by the lack of trained clinical staff and by limited access to appropriate laboratory facilities and other necessary health care facilities. While some PLHAs in resource poor countries are receiving HAART, some are receiving monotherapy and others are receiving any available ARV drugs for weeks or months until they run out of money. This situation is referred to as 'therapeutic anarchy.' Taking this grave situation into consideration, the World Health Organization (WHO) convened a meeting on May 22, 2001 and submitted a report on ARV. The Department of Health has now initiated action and convened a consultative workshop to explore the possibility of providing these drugs to HIV/AIDS patients in the country. The NSACP is in the process of developing guidelines for ART. ***** How AIDS is Spread Transmission of HIV always involves exposure to body fluids of an infected person. The virus has been isolated from various body fluids. The greatest concentrations have been found in blood, cerebrospinal fluid, semen and vaginal secretions. Lower concentrations have been found in saliva, tears, breast milk, urine and amniotic fluid. AIDS is spread when blood, semen or vaginal secretions of an infected person comes into contact with the blood of a healthy person. There are three main ways by which the virus can be transmitted to another: By Sexual contact The most common way that the AIDS virus is spread is when a person has sexual intercourse with a person who already has the virus. An infected man has the virus in his blood and semen. An infected woman has it in her blood and vaginal secretions. The virus can be passed on either in sexual intercourse between homosexuals or intercourse between a man and woman - from an infected man to a woman, and from an infected woman to a man. By transfusion of infected blood or blood products If the blood or blood products containing the AIDS virus is given to an uninfected person, then that person becomes infected with the AIDS virus. Transfusion of unscreened blood is dangerous. By contaminated needles and syringes Syringes, needles, knives, razor blades, ear piercing tools or any other instrument used to cut, pierce or inject the body can contain the blood or a person infected with the AIDS virus. If such instruments are used without proper sterilization, then the AIDS virus can be passed on to an uninfected person through these instruments. Needles and syringes are a common mode of transmission of the HIV among intravenous drug users. By an infected pregnant woman To her unborn child during pregnancy or childbirth. Approximately 15-25% of infants born to infected mothers will be infected with the virus. How the AIDS virus does not spread No case of transmission of the virus is known to have occurred by... Touching or shaking hands of a person who is infected with the virus. Living together with an HIV infected person Playing together. Swimming in a pool or river, with an infected person. Kissing of lips of an infected person. Sharing cups, plates and other utensils used by an infected individual. By being bitten by insects such as mosquitoes, bed bugs etc. By coughing or sneezing. By contact with towels, bed linen etc., used by an infected person. By toilet seats used by infected persons. By donating blood. Some people even fear that donors may catch AIDS by giving blood. There is in fact no risk when sterile equipment is used for blood collecting. It is also not spread by food or water. |
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