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Kenya: Puzzle of deaths among patients on HIV treatment

Half of the people who die of HIV-related illnesses are on antiretroviral drugs, a new report has shown, raising questions about whether they are strictly following their medication regimes.

This is happening despite the ongoing “test and treat HIV programme” carried out by the national and county governments to ensure that all infected Kenyans receive free antiretroviral drugs.

According to the 2018 Kenya Aids Response Progress Report, 23,903 people died of HIV-related illnesses last year.

Of these, 11,955 were on medication while another 11,948 were not. However, the number of men who died was higher than that of women.

According to the report, HIV/Aids killed 13,823 men compared to 10,074 women.

COMPLIANCE

Earlier this week, health experts said more men could be dying because fewer are tested and men, generally, are poorer at seeking health services.

The fact that the number of deaths among those on treatment and those that are not is almost the same is an indication that there is a serious problem.

Dr Dismas Oketch, the principal investigator with the HIV Prevention Trials and Linkage to Care Unit at the Kenya Medical Research Institute Centre for Global Health Research, attributed the deaths to lack of adherence and getting treatment late.

“The number of defaulters is becoming a concern. That’s why we are reducing the number of new infections but HIV-related deaths continue to grow,” Dr Oketch said.

According to the data, HIV prevalence and new infections have declined but deaths have continued to increase over the years.

INFECTIONS

HIV incidence among adults aged 15-49 had reduced from 0.35 percent in 2010 to 0.19 percent in 2017, possibly due to various prevention and treatment programmes.

In terms of absolute numbers, new HIV infections among all ages declined from 77,200 in 2010 to 52,800 in 2017, indicating a 32 percent decline in the number of new annual HIV infections at the national level.

Annual new HIV infections among adults aged above 15 also declined from 63,700 in 2010 to 44,800 in 2017, a 30 percent drop.

Among children, new infections declined from 13,500 in 2010 to 8,000 last year, which shows a 41 percent reduction over seven years.

Among young people aged 15-24, new infections declined from 28,800 in 2010 to 17,700 in 2017.

PREVENTION

However, the number of deaths has continued to rise with an increase in the use of antiretroviral treatment (ART).

The adult ART coverage was estimated at 75 percent while coverage for children was 82 percent last year.

It is believed that the increased used of medication since 2004 has saved over 635,500 lives in the country by averting deaths due to Aids-related causes.

“The number of people on drugs who have died should not be equal to those who have not started the drugs,” Dr Oketch said.

HIV treatment can reduce viruses in the blood (also known as viral load) and other bodily fluids to undetectable levels.

The drugs work by controlling the replication of HIV in the body by reducing the virus’ ability to make copies of itself.

“The drugs slow down the damage that the virus does to the immune system and allow people to live long, productive lives like everyone else without succumbing to the disease. These drugs are tremendously valuable in giving an excellent quality of life,” he said.

RESISTANCE

Dr Patrick Oyaro, a researcher at RCTP-Faces, an NGO that supports HIV research in western Kenya and Nyanza, said if one has HIV and stops taking treatment, the virus becomes resistant to the ARVs.

As a result, even if one resumes the drugs later, they might not work.

“If one starts, they should not stop. If the drugs are stopped, or not taken at the right time each day, the HIV virus takes advantage of this and starts to make copies of itself again. Sometimes the copies change a little bit, and the ARV drugs will not be as effective against them,” Dr Oyaro said.

He advises that along with medication, one needs to adopt good lifestyle habits such as eating well, avoiding alcohol, engaging in safe sex, sleeping well and exercising.

By Daily Nation

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