THOSE JAMAICANS living with Acquired Immune Deficiency Syndrome (AIDS) and in need of antiretroviral therapy number around 8,000 and counting, but for various economic and social reasons only a measly 600 of them are consistently on this life-saving treatment.
The scope of the problem accessing the expensive treatment for Jamaicans living with AIDS is not lost on Dr. Harvey. He told the delegates attending the second-day of an HIV/AIDS symposium convened by a Jamaica/Florida group, Building Bridges, that even with such dismal access to treatment, the country was only seeing the tip of the iceberg.
It's the tip of iceberg because with an adult prevalence rate of 1.5 per cent for HIV/AIDS infection, it is estimated that between 22,000 and 25,000 individuals here are now living with the human immunodeficiency virus (HIV); many of them do not yet know that they are infected. Furthermore, the case fatality for HIV/AIDS is 60 per cent, that is, six in every 10 persons with AIDS are dying.
ALL NOT LOST
"Once they develop AIDS within one to two years most of them die," said Dr. Harvey.
All is not lost, however, as there is some hope for increased access to antiretroviral therapy in an international fund known as the Global Fund for HIV/AIDS, tuberculosis and malaria. A grant agreement was signed in May by Health Minister John Junor in Geneva, Switzerland. It is therefore expected that the local HIV/AIDS fund should boosted by US$23 million over the next five years.
It is this injection of funds which Dr. Harvey said could assist local health professionals "to rapidly scale up" antiretroviral medications to persons infected with HIV/AIDS.
"In order to deliver this service, we are implementing integrated treatment care approach, where treatment centres are being integrated into existing medical facilities and we have 15 such centres across the island... to date most have started managing patients on antiretroviral drugs," he said.
TREATMENT PROTOCOL
With antiretroviral therapy soon becoming a normal part of the mix of treatment options available to persons in the public sector, Dr. Harvey also reminded health professionals attending the conference of the treatment protocol. The patient's history should be taken, then examinations, investigations and
follow up. He said that physical examination of the patient was important and should repeated every six months initially.
"Pay particular attention to the skin, eyes and oral cavity, lymph nodes, spleen. For women, remember to do a Pap smear every six to 12 months; once you get two or three normal ones, then you can do it (less frequently)," he advised.
Laboratory evaluations, Dr. Harvey said, are also important in the management of patients with HIV/AIDS. Since the local facilities are now able to do CD4 count monitoring, he said that these tests should be done at baseline and should be done routinely. The CD4 (T-4) cells protect the body against germs such as viruses, bacteria, parasites and fungi but these cells are also attacked when an individual is infected with HIV, thus limiting the protective capacity of the body immune system. The number of CD4 cells falls as a result of HIV infection and therefore routine counting of the cells gives the health professional some guideline for patient
management.
Dr. Harvey said, for instance, that patients can be categorised based on their CD4 count. If the CD4 count is greater than 350 then, he said, patients should be managed symptomatically, and the CD4 count repeated every six to 12 months. If the CD4 count is less than 350, then the CD4 count should be repeated every three to six months, and prophylactic treatment should begin. If the CD4 count is less than 200, then the patient should be monitored every three months initially and the recommendation is for antiretroviral therapy and other prophylactic care.
"So our recommendation for antiretrovirals is for anybody with a CD4 count less than 200 or anybody diagnosed with clinical AIDS based on the WHO classification," Dr. Harvey stressed.
With this knowledge patients can monitor their health management along with their health care provider.
Viral load monitoring is also important in HIV/AIDS management but this test is not yet available locally, and Dr. Harvey said that in the local management of HIV/AIDS patients it is optional.
He stressed that managing patients using the HAART highly-active antiretroviral
therapy is a combination of three drugs and that health care providers should not give their patients just one or two drugs but three.
