Botswana is one of the most affected countries when it comes to HIV/AIDS. With a population of about 1.6 million it is estimated 23.9% of the adult population may be HIV positive. In the early 1990s people were dying continuously. There was hardly a weekend that we didn't have a funeral to attend. But then the magic of ARVs arrived. Thanks to generous donations from overseas and the commitment of our own government, ARV treatment is free to everyone. This may be a mixed blessing.
When everyone was dying people had a hopeless mentality, myself included. Fate will see what to do with me. Now ARVs have arrived and we now try to look on it as any other long term chronic disease. Both of these mindsets continue to keep the infection rate fuelled with new cases.
This article in The New York Magazine suggests that long term use of ARVs has its own side effects. These effects include premature ageing including early onset Alzheimer's Disease, cancers, and other age related conditions such as insulin resistance and cholesterol problems. Scientists are not sure if these health problems are as a result of long term ARV use or the fact that HIV is in the body.
"A study presented at a conference in February in Montreal showed that otherwise healthy people on HIV medications at about 56 years of age had immune systems comparable to HIV-negative subjects whose median age is 88. Perhaps as a result, many diseases that typically attack the very old are striking younger HIV-positive people disproportionately, like diseases of the liver, kidney, heart, and veins. One study found that 55-year-olds who are HIV-positive have all the telltale signs of late-life frailty—muscle loss, fatigue, and rheumatological disorders. "
Another very disturbing piece of information is that African -Americans seem to fare worse on ARVs. For example, they have a much higher chance of developing kidney disease as compared to their white counterparts on ARVs.
Scientists have tentatively concluded that the age related bone loss in ARV patients is likely due to the medications while the brain issues are probably from the HIV. Protease inhibitors in the ARV cocktail seem to be the culprit when it comes to impairments in cognitive function. Recent research shows about 10% of HIV positive people on ARVs have cognitive impairments. It appears that HIV can continue replicating in the brain when some of the cocktails have chemicals that cannot pass through the blood/brain barrier.
Of course ARVs have helped to save millions of lives around the world, but these new findings are disturbing. Still the best thing is to avoid contracting the disease , firstly, but then keeping yourself healthy and your CD4 count high enough so that going onto ARVs doesn't have to happen for a very long time.
I have so many HIV positive friends and this article was very disturbing because in Botswana, on this issue- the long term effects of ARV use, everything is deadly silent.