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Treating HIV/AIDS-Related Illnesses
Preventing Opportunistic and HIV-related Diseases
The best way of preventing opportunistic infections is by taking antiretroviral drugs. However, for people with CD4 counts higher than 350, antiretroviral therapy is not recommended (see antiretroviral treatment below).
People in other stages of HIV infection can prevent and treat opportunistic infections that may occur before they develop AIDS.
Most opportunistic infections are caused by common micro-organisms that may live in a person's body for years. The bacteria that causes tuberculosis, for instance, is carried by a third of the world's population, but only about 8-million people contract active tuberculosis every year (see Tuberculosis and HIV/AIDS below)
Because HIV makes the immune system weaker, these common micro-organisms have far greater "opportunities" to attack the body.
Common strategies for the prevention of opportunistic infections include:
The prevention of the micro-organisms that cause opportunistic infections
In some cases, people can prevent the micro-organisms from ever reaching their body by being careful while handling food and drink, handling pets and while having sex. However, these measures do not prevent the re-activation of micro-organisms already in the body.
Primary prophylaxis
HIV-infected people can prevent an opportunistic infection from first developing by taking special prophylactic treatment. There are common opportunistic infections that occur at predictable CD4 count levels, making it easier to predict and prevent these infections.
Secondary prophylaxis
Once a person has experienced and treated an opportunistic infection, they can prevent additional episodes of the infection by taking "maintenance therapy", usually consisting of smaller doses of drugs taken for the original infection.
Both these prevention techniques carry the risk of drug resistance and side effects associated with long-term prophylaxis.
Common preventative measures in South Africa include:
offering symptomatic patients co-trimoxazole (an antibiotic treatment that prevents bacteria from reproducing) to prevent infections such as pneumocystis carinii pneumonia (PCP), toxoplasmosis, bacterial pneumonia and diarrhoea
administering a PAP smear (a scrape of a woman's cervix) to detect cancers that can be treated
Some common opportunistic conditions associated with HIV/AIDS include:
Condition/Disease
Description
Tuberculosis
An illness caused by bacteria that infects the lungs, but can be found in other organs. Read more on AIDSmap
Chronic Diarrhoea
Caused by many types of infection, diarrhoea usually results in frequent bowel movement, stomach pains and a liquid stool. Read more on AIDSmap
Pneumocystis carinii Pneumonia (PCP)
A lung disease cause by a fairly common micro-organism that usually only infects the lungs when CD4 counts fall below 100 cells/mm3. Can also grow in other parts of the body. Read more on AIDSmap
Kaposi's sarcoma (KS)
A cancer that causes lesions on skin but can spread all over the body. Read more on AIDSmap
Most opportunistic infections are treatable, although some require special attention due to the interaction between antiretrovirals and other types of drugs. Once AIDS develops, opportunistic infection treatment is less likely to be successful and the infection can result in death if antiretroviral treatment is not taken.
Opportunistic Infections and Mortality
Deaths associated with opportunistic infections can give an indication of the progress of the HIV/AIDS epidemic.
The Economic Benefits of Providing Treatment
Providing treatment eases the burden on the hospital services.
In 2001, research commissioned by the SA National Department of Health found:
628,000 admissions to public hospitals were for AIDS-related illnesses
the cost of hospitalising AIDS patients at public facilities was likely to be at least R3.6-billion, or 12.5% of the total public health budget (source)
A 2002 joint HSRC and Medical University of SA (Medunsa) study into the impact of HIV/AIDS on the health sector, found:
An estimated 15.7% of health workers in public and private hospitals were found to be HIV positive. However, among those aged 18-35, the prevalence was 20.0%. Single African nurses were found to be most at risk
A total of 28.0% of patients attending public and private health facilities, including clinics, tested positive for HIV antibodies
Patients with HIV/AIDS stayed in hospital for an average of 13.7 days, in comparison to the 8.2-day average of HIV-negative patients. (source)
Providing treatment will reduce the number of orphans
In the absence of treatment it has been estimated that approximately 5.7-million children would have lost at least one parent by 2014 (source). This may result in increased juvenile crime, lower literacy levels, and an economic burden on the state. It will also place a burden on the state to provide foster child grants and care for an increasing number of orphaned children
Providing treatment reduces social and political costs
Treating working-age people in the public and private sectors will allow them to work longer and reduce the cost of training new staff if HIV is left untreated. The international political damage caused by South Africa's prior AIDS treatment policy could also be reduced.
