Human Immunodeficiency Virus (HIV) remains as one of the largest pandemics in the world. Since its outbreak in North America in the early 1970s, approximately 75 million people have become infected with HIV. Currently, approximately 37.5 million people are living with HIV while 22 million are already on treatment.
HIV attack and destroy infection-fighting cells of the immune system known as CD4 cells. In a person with a healthy immune system, CD4 counts are between 500 to 1600 cells per millimetre cubic (cells/mm3). Loss of CD4 cells in the body makes it hard to fight off infections and certain cancers. If HIV remains untreated in an individual, HIV gradually destroys the immune system and eventually will progress to the advanced stage of HIV infection which is called Acquired Immunodeficiency Syndrome (AIDS). A person is considered to have progressed to AIDS when CD4 cells fall below 200 cells/mm3 and when they develop one or more opportunistic infections regardless of CD4 counts. HIV can only be transmitted from an infected person through blood, semen, pre – seminal fluid and breast milk. HIV is not spread by air or water, insect bites, touch and sharing items such as sharing dishes and silverware.
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In the past, when HIV was still poorly understood, the outlook of patients with HIV was grim. With no antiviral available to fend off HIV, only treatment for opportunistic infection could be offered while the immune system of the infected person continue to fail. The first antiretroviral therapy (ART) for HIV, Zidovudine, was approved for use in 1987. Yet, even when the following years witnessed development of many other ARTs, researchers continued to face myriad of treatment failures and disappointments. The reality of HIV treatment during the first decade was startlingly unsuccessful.
In 1996, highly active retroviral therapy (HAART) was introduced as the treatment standard and has since lead to an impressive 60 to 80 per cent decline in death rates. HAART is a customised combination of two or more HIV medicines.
HAART works by preventing HIV from multiplying thus protecting CD4 cells that the virus would otherwise target. The aim of HIV treatment is to attain undetectable viral load which essentially means that the amount of HIV in a blood sample cannot be detected by using a standard test. Reducing the amount of HIV in the blood allows the immune system to strengthen. When CD4 cell counts increase in a person with HIV, the risk of becoming ill because of HIV becomes lower. Although HAART does not cure HIV, it can make a HIV infected person live longer and healthier. In addition, HAART also reduces the risk of transmission.
According to studies, in order for individuals with HIV to fully benefit from HAART, it is imperative for them to know they are HIV infected, be engaged in regular HIV care and receive as well as adhere to effective ART. However, there are several other obstacles that contribute to poor engagement to HIV care even after a person has acknowledged his or her HIV status. Subsequently limiting the effectiveness of efforts to improve health outcomes for those with HIV. To address this, a HIV Care Clinic comprise of a multidisciplinary team of doctors, pharmacists, nurses, medical assistants and peer support group which is usually managed by non-governmental organisation. Together, they provide care, treatment and comfort to the patient.
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In HIV care, pharmacist works to develop medication treatment plan in a programme known as Medication Therapy and Adherence Clinic for Retroviral Disease (MTAC RVD). Since treatment success requires lifelong commitment and the highest level of discipline, pharmacist provides comprehensive information about HAART to patients. The service provided is tailored to meet the needs of individual patients and address their specific concerns. The patients are made to understand that delaying or skipping HAART will allow the stronger mutant virus to multiply and this may eventually cause treatment failure. Additionally, the pharmacist will review all prescription and non-prescription medicines, vitamin supplements, nutritional supplements and herbal products that is taken by patient to ensure HAART does not interact with any of them. Drug interactions may cause decline in efficacy or give rise to unwanted side effects.
Pharmacist also helps patient to address issues that lead to poor adherence to medications. The reasons for non-adherence to HAART are extremely varied. The causes may be patient-related such as health literacy and sociodemographic factors. Adherence is also impacted by inconvenient dosing frequency, dietary restrictions, pill burden and side effects. The challenges in the system of care itself, such as difficulty accessing healthcare services, may also reduce the likelihood for a patient to take medication appropriately. Patient adherence to HAART will be regularly assessed in MTAC RVD. When non-adherence is detected, the reasons are identified and the strategies to address them are brain stormed and implemented. For instance, patients with busy schedule or constantly forgetting to take HAART are provided with adherence aid tool such as pill box. For those who are unable to take HAART on their own due to physical and neurological disability, counselling and education on medications are offered to family members. For reasons that cannot be addressed by the pharmacist, parties with the best resources to solve the problem will be connected to the patient.
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Another issue that deserves undivided attention is HIV-related stigma and discrimination. People living with HIV today are still facing prejudice, negative attitudes and abuse across the globe. The fear of HIV rooted from the image of HIV back in the 1980s where it was falsely believed that HIV is always associated with death, is associated with behaviours that some people disapproved and the result of personal irresponsibility and moral fault. But in reality, there are other ways of contracting the infection other than engaging in high-risk behaviours. For example, women and children in certain parts of the world are more vulnerable to be infected with HIV due to unequal cultural, social and economic status in society.
It is proven by studies that many of the people most vulnerable to HIV are stigmatised and pushed to the margins of society where poverty and fear makes accessing healthcare and HIV services difficult. Stigma and discrimination is also found as the main reason why people hesitate to be tested, to disclose their HIV status and start on treatment. Late detection and treatment will contribute to further expansion. There is an urgent need to address this matter as it hinders the efforts to stem the epidemic.
HIV is undeniably not an easy virus to defeat. In 2014, The Joint United Nations Programme on HIV and AIDS (UNAIDS) launched the “90-90-90” target with the aim to end AIDS epidemic by 2030. The targets were that 90pc of all people living with HIV will know their status, 90pc of all the people diagnosed with HIV infection will receive sustained antiretroviral therapy and 90pc of all people receiving antiretroviral will achieve viral suppression.
Now the world is at the crossroad. HAART which was previously known as the “AIDS cocktail” changed what was universally fatal and catastrophic into a manageable chronic illness. Nevertheless, achieving optimal adherence for those who are already on treatment continue to be challenging. Adherence is dynamic and not static. It changes with time thus there is need for persistent programmatic effort to ensure the benefit is well maintained. Therefore, the best practice in order to end the HIV epidemic will be the incorporation of comprehensive multidisciplinary approaches that encompass medium for early detection of HIV infection, provision of timely treatment, programmes that facilitate retention of care as well public awareness. Together we will end AIDS.
Written by:
Norhaziah Mohamad Salleh,Stay up-to-date by following Daily Express’s Telegram channel.
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