AIDS can be treated! Don't get it wrong

Chris W. Green, Yayasan Spiritia, Jakarta, chrisg@rad.net.id

"There's no cure for AIDS." For many, this is the only accurate thing they know about the disease. Unfortunately, when translated into Indonesian this becomes "AIDS tidak ada obat", or "There's no medication for AIDS". This is certainly not true.

Many may have already heard about the antiretroviral drugs that, if taken properly, can make AIDS a chronic manageable condition like heart disease or diabetes. These drugs, which began to be widely used in the developed world by 1996, were initially very expensive, costing around US$15,000 a year. This was clearly beyond the means of most people with AIDS in developing countries.

Now, however, with many of the drugs being produced by generic manufacturers in India, Thailand and Brazil, the prices have fallen sharply. They can now be obtained in Indonesia for Rp 650,000 per month -- still not cheap, but certainly more affordable.

Not everyone infected with HIV needs to take these drugs. The best time to start treatment is still the subject of much debate, but it does not become urgent until the virus develops into AIDS, which usually occurs about seven to 10 years after infection.

If you recall Sulasi, the woman from Malang that appeared in The Jakarta Post article last Nov. 27, she was diagnosed HIV- positive in 1991. During our research trip for the article, she and I stopped off in Bali to meet other members of our network of HIV-positive people there, and Sulasi also arranged to have a test to measure the number of CD4 cells in her blood.

The CD4 count provides a measure of the health of the immune system. It is this system that HIV attacks and damages. Healthy people normally have a CD4 count of more than 600. A count of 200 indicates significant damage to the immune system, and means that the patient has AIDS.

Sulasi's CD4 count was 150, which meant that the damage to her immune system was quite advanced. With such a low count, she was vulnerable to a number of what are called "opportunistic infections". These generally result from bacteria, viruses or funguses that normally live in our bodies, but which are kept under control by a healthy immune system. However, once the immune system has been damaged, in this case by HIV, these organisms can run riot.

Often, the first to appear is an infection caused by a fungus called candida in the mouth, resulting in thrush, which is common in childhood. Generally, thrush is easily treated.

The first serious illness to appear is typically PCP, a form of pneumonia, again caused by a fungus. PCP usually requires hospitalization. Later, if the CD4 count drops below 100, a parasitic infection called toxo can appear, which often affects the brain. Most of these opportunistic infections can be treated, although the treatment may take a long time and be expensive.

More importantly, however, a daily dose of a relatively inexpensive and readily available medicine, called cotrimoxazole, can prevent many of these infections. To ensure effective protection, people living with HIV/AIDS should start taking cotrimoxazole before their CD4 count falls below 200. Although Sulasi started late, luckily, it seems she is still quite strong and healthy, so she may have started the treatment in time.

While cotrimoxazole can prevent some infections, it will not stop the continuous damage to her immune system. If she undertakes no additional treatment, chances are that she will no longer be with us in two or three years -- no longer around to bring up her two children, or to continue to play a vital role in helping others understand what it means to be living with AIDS.

This is where the antiretroviral drugs come in. If Sulasi can take them, they will stop the virus multiplying in her body and allow her immune system to recover. They will also give her the hope of seeing her children finish school, and of pursuing an almost normal life.

However, Sulasi cannot afford a Rp 650,000 monthly medical expense for even a few months, let alone for the rest of her life.

Fortunately, an anonymous benefactor from Australia appeared, and offered to pay for these drugs for Sulasi for one year.

Sulasi will be the third woman with AIDS in Indonesia to receive such support. The first, Yuni (her real name, printed with her permission) started taking cotrimoxazole almost a year ago, when her CD4 count was 17 and she was at death's door. A week later, she was released from the hospital, and a few months later, she joined us on our grueling 16-day trip visiting four towns in Papua. Yuni is still fit and well, and support for her treatment has been extended for another year.

There are, of course, many more like Sulasi and Yuni around the country, and they also need such well-wishers who may be able to give them the future to which Sulasi now looks forward.

While our group is lobbying local governments to do their share, we cannot expect that this will come close to solving the problem.

Sulasi has returned to Malang, where she will meet a doctor who has agreed to look after her once she starts the antiretroviral treatment. The doctor is also new to this, so they will learn together.

Sometimes, the side effects of the drugs can be quite severe during the first few weeks. Let us hope Sulasi gets through this stage with as little discomfort as possible, and we will report on her progress within a few weeks.

These new drugs, and the well-wishers who are helping people like Sulasi to obtain them, are changing the future of AIDS. The knowledge of the availability of these drugs, treatment and helping hands, encourage more people to get tested and find out whether they are infected. In turn, more people who know that they are infected can take more care to ensure that they do not pass the virus on to others.

In this sense, treatment is truly a vital part of prevention.