Apologies for the loss of contact....Spent a day in a different hospital on the Friday 19th, so I stayed in Point Hill on the Thursday nite.....where there is no Internet of coarse....and have only just reached back.( I will fill you in on Friday's experience soon xx)
So the Sister in charge is HIV Specialist Jacynth Moore who once again to no surprise is a Midwife/Nurse. The service is called CHARES which stands for: Centre HIV AIDS RESEARCH EDUCATION SERVICE. Women and children travel across the island so they are not recognised by their community to be attending a HIV Clinic.Fact!!! They could travel up to 5 hours or more.There is still a stigma around the HIV virus amongst different community's. The Clinic caters for 0-24 year old and pregnant women. At the age of 21-22 years, the individual starts to get prepared by a counsellor for them to "go it alone" as they would term it. Fact!!!! Remember that there are individuals who have been attached to this clinic from birth and guided through the process of life...and safe practice of sexual intercourse, furthermore the clinic guides and sometimes facilitates the process of explaining to a child at the age of 8 onwards about the disease they have.....for example: Children who have the virus from birth, do not know that they have a disease, they just know that they visit a clinic often and it's a part of their life. Parents sometimes find it difficult to explain to their child, that they have the disease which they contracted from their parents, and some parents find it very difficult and struggle with letting their children know, and procrastinate for years......The counsellors feel that children cope better at a younger age learning they have HIV. The Staff are very sensitive to each individual and each case is dealt with in it's personal way.
The women who are diagnosed with an AIDS defining illness, TB, Hepatitis B or HIV Associated Nephropathy (HIVAN) are started on a treatment which is known by the name of HAART, which stands for Highly Active Anti Retroviral Therapy.
There are 3 types of therapy that are available....First line therapy, second line therapy and Salvage therapy (which I will comment on later...)
The medication prescribed is a combination of 3 drugs, which comprise of either Tenofovir and Emtricitabine or Zidovudine and Lamivudine (which are both Nucleoside Reverse Transcriptase Inhibitors, (NRTI), and then Efavirenz or Nevirapine ( which are both Non-Nucleoside Reverse Transcriptase Inhibitors, (NNRTI). This is the preferred option for patients (pregnant women ).
Follow up treatment is: a CD4 count at 3 months and 6 months, then once every 6 months. A Viral Load at 6months after commencing on the HAART and then at 12 month intervals.
Fact!!!!!.......CD4 tests measure the number of CD4 T-cells in the blood to gauge the strength of the immune system in the presence of HIV infection. It is also used to monitor the overall condition of the patient’s immune system. The test has two main limitations with regard to HIV management. First, there are many factors, other than HIV activity, that can affect the amount of CD4 T-cells present in the blood at any given time. So the doctor cannot be sure if the CD4 value is caused by HIV activity or other factors. Second, it can take up to 6 months for HIV activity to be reflected in the CD4 count. (Deep Breath....Exhale.....)
Fact!!!!The viral load test measures the number of virus particles in the blood directly. A low viral load indicates that HIV is not actively reproducing and that the immediate risk of disease progression is low. A high viral load means the virus is active and the infection will progress. The viral load test is a more reliable indicator of viral activity than the CD4 test and, as such, a more reliable indicator of disease progression. It is the most useful tool in determining whether or not antiretroviral drugs are working since treatment failure is first manifested by a rise in viral load. In virtually all cases, this rise in viral load occurs within a month or two of the cause of treatment failure. (You learn something new every day.....well I am!!!!)
Failure can only be assessed in patients who are over 95% adherent to the therapy....(for that reason patients are routinely quizzed about how they are taking their medication, when they take it, how they take it, if they are having any complications, what they are eating, how their diet is, how their well-being is....) taking all of the above in to account, if they still have:
- A confirmed viral load greater than 400 copies/ml in a patient on HAART for more than 6 months and a previously undetectable viral load
- Falling CD4 Count of more than 30% decline in 6 months
- Clinical progression or development of new or recurrent Opportunistic Infections despite being compliant with medications for at least 6 months
The 3 x medication is Zidovudine and Lamivudine or Tenofovir and Emtricitabine (which again are both Nucleoside Reverse Transcriptase Inhibitors (NRTI), and Lopinavir and Ritonavir or Atazanavir and Ritonavir ( which are Protease Inhibitors (PI).
If the patients treatment fails the second regime....then the SALVAGE THERAPY begins.......I was advised that the reason for the name "salvage" is because that's exactly what is meant by the treatment.....and that by the time the patient is on this type of vigorous therapy......the probability does not look good....: (.....
Fact!!!!!Did you know that a PCR-(Polymerase Chain Reaction) can be detected as early as 4 weeks in a infant. This is carried out by a collection of Dried Blood Spots (DBS) It is carried out like our Guthrie's!!!!(Heel prick and 5 blood spots).
Last but least!!!!.l.......HIV is a reportable disease in Jamaica and the cases are sent to the Ministry Of Health and Surveillance Unit.
A lot to take in ....I KNOW......
Good nite Bloggers xx
Miss P
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