A recent article in The Guardian addressed the importance of staging HIV disease (determining how aggressive and advanced the disease is) at the time of diagnosis and during treatment.
Advances in medicine’s understanding of HIV are making in increasingly clear that the earlier a patient infected with HIV is treated the better. New guidelines will be promulgated that support starting treatment at CD4+ levels of 500/mm3.
Equally important in managing HIV disease is the ability to measure viral load. There is no better way to determine if the HIV treatment being given is working or if resistance to the drugs has developed.
Coincident with these advances, new diagnostic technologies are coming on line that will permit wider and more immediate measurement of both CD4 and viral load. The Guardian points out, however, that these new technologies present severe challenges to the largely underfunded and often weak regulatory bodies in African countries and notes that multinational efforts are underway to “harmonize” and regulate the entry of these technologies into African markets.
In general, these advances will be a boon to palliative care in Africa. When those living with HIV are treated earlier in the course of their disease they become less likely to become ill and suffer end-organ damage from the virus. If their viral loads are effectively suppressed they are also less likely to pass the virus onto others through sexual contact or other means. Taken together, these mean that the overall burden of disease on the continent will be reduced.
Additionally, because palliative care begins at the time of diagnosis, the palliative care provider (or provider with a palliative care orientation) will, with these new diagnostic tools, have additional important information to share with the patient and family and, in some cases, additional sources of encouragement and comfort.
Introduction of these technologies and treatment of HIV infected patients at higher CD4 counts will, however, almost certainly increase the cost of HIV treatment and could, without continued strong advocacy for palliative care, erode what little financial support for palliative care exists in national health budgets. The palliative care community in Africa would do well to embrace these advances but, at the same time, redouble efforts to insure that support for palliative care not slip or be diminished.
An additional issue regarding these new diagnostic technologies was not mentioned in the Guardian piece: The widespread problem of counterfeiting drugs and the potential for counterfeit diagnostic tests in Africa. Many African regulatory and law enforcement agencies have taken aggressive stances against this problem but it is a sad fact that many people are badly hurt when they are given fake drugs or faulty diagnostic tests. The palliative care community must be aware of both the scope of this problem in their community and of the ways that it can be mitigated.
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