Care and support for people living with HIV/AIDS

Care and support for people living with HIV/AIDSBetter prospects for preventing infections in those with HIVGiven the limited diagnostic facilities available in developing countries and the highcosts of many drugs for treating opportunistic infections, let alone antiretrovirals, theoption of prevention is receiving renewed attention. The bulk of evidence now suggeststhat a few relatively inexpensive drugs could help ward off severe illness andadd months, if not years, to the lives of HIV-positive people in even the poorestdeveloping countries. Indeed, preventive drugs had begun to prolong survival in thehigh-income countries even before antiretroviral therapy was available.One drug is isoniazid, which has been shown to be effective in warding off 60% ofactive tuberculosis episodes in people with HIV. In at least one study, isoniazid preventionprolonged life significantly for those who were infected with both HIV and thebacillus that causes tuberculosis. A simple regimen costs on average just a fewcents a day for both the medicine and the health services involved.Tuberculosis prophylaxis is especially important because in half the cases HIVinfectedindividuals develop a form of TB which cannot be easily diagnosed andwhich thus goes untreated. Diagnosing disseminated tuberculosis requires sophisticatedlaboratory equipment that is largely unavailable in many of the poorer developingcountries. This is why UNAIDS and WHO have recommended since 1998 thata simple and inexpensive regimen for preventing tuberculosis should be part of theessential care package for people with HIV (see Table 1, page 98).New developments point the way to preventing other severe infections.Cotrimoxazole – a pill combining an antibiotic and a sulfa drug which has helpedprevent Pneumocystis carinii pneumonia, the biggest AIDS-related killer in highincomecountries – was tested for its preventive impact in Côte d’Ivoire. In one studyin Abidjan, where the drug costs of a 12-month regimen were just US$ 17.50, cotrimoxazoleprophylaxis resulted in significantly fewer severe infections (as measuredby hospital admissions). In another study, cotrimoxazole warded off infections sosuccessfully that it extended life by half a year. The drug combination appeared tobe effective in preventing some bacterial pneumonias, diarrhoeal diseases andinfections of the blood, and possibly toxoplasmosis (a parasitic brain disease) andisosporiasis (a parasitic infection of the intestines).In the light of these hopeful findings it is urgent to implement cotrimoxazole regimensin sub-Saharan Africa as part of the essential care package for adults and childrenliving with HIV (see Box 20). At the same time, scientists will need to keep carefulwatch so that the value of this drug combination is not undermined by the developmentof resistance to it.105