According to Ford and Doherty (2017), until recently, the battle against HIV was measured by the number of patients who began antiretroviral therapy (ART) (Antiretroviral Therapy). For the past 15 years, efforts have been made to boost ART access in the middle and low-income countries that are most affected by the HIV pandemic. The process was a success, as it helped prevent more than 8 million deaths caused by the virus. The interventions have greatly improved the population’s life expectancy in these low-income countries.
Despite these optimistic efforts, HIV nevertheless kills over one million people per year around the world. In particular, in Sub-Saharan Africa, it continues to be the leading cause of complications and death. The principal cause for this is that HIV is identified in individuals while at its advanced stage. A worrying emerging trend has been noted whereby these affected countries have recorded that there is an increasing number of patients who are in need of ART after stopping treatment for a significant period.
The writers considered a published report that describes prophylaxis packages used to reduce the mortality risk facing patients with advanced HIV infections. This package was applied in four African countries namely Kenya, Uganda, Malawi, and Zimbabwe. The content of the package includes azithromycin, fluconazole albendazole, and a dose combining trimethoprim-sulfamethoxazole, pyridoxine, and isoniazid. The package aims at providing protection against the infectious reasons for HIV patients’ hospitalization or death. These communicable diseases are usually acute bacterial infections, tuberculosis, and cryptococcal infections.
The trial of the package had a 24-week cutoff after which outcomes could be measured. On the cut-off week, it was noted that the patients who used the enhanced-prophylaxis had an improved survival rate. The primary outcome was that the package lowered the death rate among people who took it despite starting the ART process late unlike those who took the standard prophylaxis. They also noted that new scenarios of TB were significantly lowered by the used of the enhanced-prophylaxis unlike when using the standard prophylaxis.
With the new package, an acceptable profile of side-effects was noted. Also, it was observed that there was a high level of adherence to the package and no noticeable effect on ART processes despite the burden of pills to the patients. However, the researchers did not find a difference between the groups concerning the effects of the critical bacterial infections.
The improved-prophylaxis medication service is well-applied in areas with limited laboratory access for the investigation of issues involving TB diagnostics, testing of cryptococcal antigens, and the culture of relevant bacteria. The approach is well-suited for reducing complaints and deaths from these rapidly occurring common causes in the regions. However, despite the benefits of this method, there exists a potential risk regarding microbial resistance to the azithromycin and fluconazole. Moreover, the blanket prophylaxis seems to be an expensive affair in these locations.
With the discovery of new-fangled HIV treatment alternatives, HIV infections have been watered down from being similar to a death sentence and can be seen as a manageable chronic disease. The new methods only call for the HIV patients to start ART as early as possible. By doing so, their life expectancy is significantly normalized. Moreover, early treatments play a significant role in the reduction of transmission risks.
Ford, N., & Doherty, M. (2017, July 20). The enduring challenge of advanced HIV infection. The New England Journal of Medicene, 377(3), 283-284.