Tuesday, 10 November 2009

ARVs and their long-term effects..

I have been a champion of that message which says that a diagnosis of HIV infection in 2009 is not the death sentence that it was 25 years ago. Indeed, in the part of the world where I live, hardly anyone dies from HIV related causes. A newly diagnosed HIV infected person is more likely to die in a road traffic accident than of causes related to his HIV infection. So efficacious are the new generation of antiretroviral drugs that I always held the view that the prognosis for most HIV positive people is a normal life expectancy and the enjoyment of relatively good health for the duration, albeit living with a chronic medical condition likened to any other, such as diabetes....Until I read this article, which says that long-term dependence on ARVs can cause patients to get older faster and show early signs of dementia and bone weakness usually seen in the elderly. I read the article and it got me thinking..
"... in the last year or so, doctors have been troubled by the emergence of a new kind of AIDS story. Take the case of James L., 46. After testing positive in 2001, he went on a drug cocktail and life returned to normal with little effort. His exercise regime only intensified. He even went back to school for a master’s degree. At work, he rose to a six-figure position at a telecommunications firm, and his personal life flourished. He was, he told me, “a regular gay male.”
"Then, halfway through a screening of the film Syriana in his local cinema, he had a disturbing revelation. He sat through about half the movie before he realised suddenly that he had seen the same movie two weeks earlier. Indeed, James ultimately pieced together evidence suggesting he’d seen the film on three separate occasions. The same problem haunted him at work. Where he had once earned praise for his organisational skills, he now drew warnings. He seemed incapable of recalling recent events with any reliability. “It’s an Alzheimer’s-like state,” he explains. Earlier this year, he was diagnosed with HIV-associated cognitive motor disorder."
I am informed that the Protease Inhibitor class of drugs is the culprit and is the main cause of this "HIV-associated cognitive motor disorder". A very scary thought indeed, since most of the beneficiaries of the advanced HIV treatments that are available today are people in their 20s and 30s, in the prime of their lives. The drugs might have saved their lives in the short term, but may have the long-term effect of impairing their ability to function as fully capable, competent and productive human beings.

In countries of Africa such as South Africa, Botswana and even Nigeria where infection rates are high, the consequences for a significant segment of the population who must continue indefinitely to receive ARVs in order to stay alive, could mean in future not being able to work or to make a meaningful contribution to society, while at the same time presenting society with the added burden of providing care. James in the example given above, is now dependent on disability welfare payments..

When in 1996 these ARVs became widely available, the excitement was so great that nobody thought to foresee what the effects of the long-term use of the drugs might be. But when you think about it, there was, and still is, an immediacy of need for these medications. And being new drugs, there was never and has not been since the opportunity to test their long-term side effects, before their approval by the relevant authorities and distribution for use..

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