Monitoring HIV

By Drum Digital
26 July 2012

I’ve noticed that there’s a lot of confusion about the role of a CD4 count and the viral load in monitoring HIV/AIDS.

Let me explain the difference.

•    The Viral load is the amount of virus circulating in the living body.

•    The CD4 count is the number that indicates the amount of T helper cells (a type of white cells that fights infection) in the blood. The normal range is between 400-1600 cells per cubic millimetre.

In state owned institutions a CD4 count of 350 and below is an indicator that anti-retro-viral treatment should be started.

This is not however the best indicator for starting ARVs.

The CD4 count was around before HIV/AIDS.

What a low CD4 count really means is that the immune system is weakened. During any illness, the immune system of any person, HIV-positive or not, is compromised.

The reason these tests are done with HIV-positive patients is that it’s the best way to keep track of how much virus is in the blood in order to treat the patient accordingly.

The virus is what attacks the tissue, and weakens the system, making the patient vulnerable to opportunistic infections. Therefore nothing else will be effective in fighting the virus.

While immune boosters, vitamins, exercise and a balanced diet have their place, nothing can do the job that ARVs do. Without them, HIV will continue to  multiply.

ARVs will not completely remove the virus but will lower it to undetectable levels (usually less than 50copies per millilitre).

At this level, the carrier is non-infectious, so the rate of transmission is very  low, hence the goal of ARV drug treatment in a person who with HIV is to reduce the transmission rate and encourage a system that has suppressed the multiplication of the virus, ruling out the chances of opportunistic infections.

When the viral load is at undetectable levels, HIV-positive people can live a full- life span if they start ARV drug treatment early enough.

Often these tests and treatment are not carried out because they are costly.

Yes, checking viral load is much more expensive than checking CD4 and the cost of monthly ARVs is also big.

So what’s the point of me bringing this up now when I know it’s not affordable for so many? I have a very good reason. When you work out the value of your life compared to the cost of the treatment? I know that for many of you, treatment is not affordable if you are completely dependent what the state provides, but for those who are HIV-positive, who can visit the GP should do so because you only have one life and you should not delegate control of it to someone else. A lot of people quickly decide they can’t afford it and yet they can afford a cell phone contract or a DSTV subscription even in the RDP houses. I say put your life first.

I am sharing this with you so that no one who is HIV positive and has family and friends, cannot say “I did not know”.  As a GP, I am a gatekeeper to medical wellness. It is my responsibility to inform the people and help them manage this disease, which is like any other chronic illness such as hypertension or diabetes. If you do not manage these conditions, the consequences are grave and so it is with HIV. There is no reason for people to die needlessly, especially when informed.

I encourage you to do all you can to treat and manage this disease. Our future depends on it.

Find Love!