HIV and the SANDF, Interview with Dr Heila Redpath

2014-09-18 12:47

Recently I had an opinion piece published at Ground Up news entitled:

People with HIV should be able to fight for their country. Found here:

The text of the above article is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Part of my research for this piece involved an interview. I sat down with Dr Heila Redpath, who specialises in HIV medicine, and set out to gather information on HIV in general and, in doing so I hoped to clarify some misconceptions and prejudice I've been seeing in last few months regarding soldiers with HIV. Dr Redpath owns, and runs a private practice in Johannesburg. I asked her some questions. Additional explanation is marked *.

Q: Does being HIV+ limit a person in terms of everyday life?

Doc: This depends on certain factors. We look at HIV patients in four stages. These stages are according to the World Health Organisation. Firstly, a WHO staging is done and CD4 count is looked at as another factor.

The four stages are:

WHO1: Asymptomatic

*patient does not display any symptoms of HIV infection.

WHO2: Upper respiratory diseases like sinusitis/tonsillitis, certain skin conditions such as folliculitis and as well as acute diarrhoea.

*Treatable and if managed correctly, will clear up just as in a person without HIV.

WHO3: Bacterial infections i.e. pneumonia, oral thrush, chronic diarrhoea and weight loss >10% of body weight.

*Treatable and, if managed well, will cleared up.

WHO4: AIDS defining illnesses, TB, Meningitis, PJP and Cancers.

* PJP,Pneumocystis jirovecii pneumonia, a type of Pneumonia caused by the fungus Pneumocystis jirovecii. It develops in the lungs.

Up to and including WHO3 staging patients can live a healthy and productive life.

*Q: What is CD4?

CD4 is a type of protein that is found on the surface of mature immune cell called a T helper cell. This type of cell plays a very important role in the immune system and these cells influence the immune response against disease. HIV targets cells that express CD4 protein.

Q: What is a CD4 count?

Doc: CD4 count is an indicator we use, to see how "strong" the immune system is.

Q: What is the CD4 for a person without HIV?

Doc: Normal values are between 500-2000, however, you do have other immunosuppressive diseases or conditions that can influence your CD4 count, such as diabetes and auto immune diseases like Sarcoidosis, Chronn's disease, all cancers and in patients on high dose steroid therapy. Any time a patient is stressed, ill or tired the CD4 drops, even in people who are HIV-.

Q: How is CD4 count brought up in patients with HIV?

Doc: Antiretrovirals are given. These increase the CD4 count, and lower the viral load.

*Viral load is a measure of the amount of HIV virus in your blood.

Q: Can you have HIV and not be on antiretroviral medication?

Doc: Yes, in some HIV+ patients, called Elite Controllers, who have very high CD4 counts and very low viral loads. This remains so for years and these patients function normally without ARVs. They have also found that some of these Elite Controllers developed their own immunity to the HIV Virus.

Q: When is it required to undergo ARV treatments?

Doc: In private practice we start patients on ARVs, with a CD4 count of 500 copies/ml. In public practice they start with a CD4 of 350 copies/ml. In some cases we start as soon as the patient seroconverts.

*Seroconversion is a process whereby the autoimmune system begins the process of developing antibodies to attack, in this instance the HIV virus. When you are tested for HIV, you're not testing for HIV virus. What is being tested is the number of antibodies your body produces to fight the HIV virus. During seroconversion, you may not have detectable levels of HIV antibodies in your blood, thus ARVs are prescribed. There are circumstances, for example, where nurses have perhaps accidentally pricked themselves during or after treating someone with HIV. They then undergo ARV treatment, such as using AZT, which may result in them not contracting HIV at all.

Q: If you were to set up ARV treatment guidelines for the SANDF what would they be?

Doc: I would start ARVs with a CD4 of 500ml/copies because it reduces the risk of opportunistic infections in the patient. Also, a regimen of Tenofovir/Emtricitabine and Raltegravir. This reduces possible psychological side effects due to use of some ARVs.

Q: Is it possible to contract HIV and live a normal life without serious problems and the HIV+ patient ever developing AIDS?

Doc: Absolutely! It is possible to live a normal, healthy life. The sooner you start with ARVs the lesser the risk of getting sick also.

Q: Are people living with HIV unhealthy or unfit?

Doc: Most people who are HIV+, take better care of their health after diagnosis. They exercise more, and eat healthier.

We need to take a second look on our stance on HIV and educate ourselves to stop discrimination against people with HIV. From what I've seen and learnt, a soldier with HIV is not a liability.

Note: The information contained in this article is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Always consult your Doctor.

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