In Case of Poor Health, Treat for HIV

Dr Joseph Sonnabend has a fascinating article on his blog about the original AZT trials, which notes that in the 1980s, many people with AIDS were dying of pneumocystis pneumonia, a preventable and treatable condition. That was in the US and other wealthy countries. But I suspect similar things are still happening in developing countries.

For example, sixty percent of people living with HIV in India are said to be dying of TB, a disease for which there are ample tests and drugs available. Dr Sonnabend notes a defeatist attitude in the 1980s but I don't think that attitude has lessened in resource poor countries.

In some countries, mothers are routinely treated with antiretroviral drugs to prevent transmission to their babies. But the health of the mothers themselves if often seen as being of little value compared to the life of  their babies.

HIV positive mothers who give birth to HIV negative babies are not likely to be seen as a priority and may become sick and even die from preventable and curable illnesses. And if mothers die, the chances of their children suffering ill health and even of dying are significantly raised. Prioritizing the needs of their babies and ignoring the longer term needs of their mothers is extremely short sighted and even self-defeating.

In Kenya, I met a number of HIV positive people who subsequently died from TB or from undiagnosed conditions. AIDS was always blamed, but the people who died were usually on antiretroviral medication. Just because they were HIV positive, it was assumed that they were going to die and when they became very ill, there was often little available to them that they could afford.

Many of them had TB, which was sometimes being treated. But even people with TB are assumed to be HIV positive, although only about half the Kenyans with TB are also HIV positive. There is little said about the massive TB epidemic raging in Kenya, unless insofar as it is associated with HIV. But it's a very easily transmitted disease and it appears to spread independently of HIV just as efficiently as in conjunction with it.

The article about India continues: "though we have 12,500 microscopy centers available across India, deaths occur mainly due to late diagnosis, owing to technology limitations". In Kenya, the problem may be due to factors other than late diagnosis, for example, lack of facilities for diagnosis, lack of access to health facilities and lack of drugs for even very common conditions.

Distribution of HIV technologies always seems to have a lot more to do with markets than about need. And when all you have is a hammer, everything looks like a nail. There seems little point in treating people with expensive antiretroviral drugs and allowing recipients to suffer from and die from preventable and treatable conditions. But who am I to tell drug manufacturers how to maximize their profits?

[For more about HIV and health care, see my other blog, HIV in Kenya.]