Today’s outing with all due sense of responsibility, I must confess is belated. But as they would say in common parlance; it is better late than never. It so happened that between the 5th and 10th of March two important events clashed. First was the Dissemination of National Guidelines for HIV Prevention, Treatment and Care 2016, document in Abuja and the second event was the annual Health Writers Association of Nigeria (HEWAN) symposium in Lagos University Teaching Hospital, Idi Araba. As chairman Board of Trustees of the health writers it was mandatory for me to be present during the event. Incidentally the event had HIV content. I was torn between two events I loved to participate in so much. Unfortunately I had already bought my flight ticket to Abuja. So I had no choice not even to toss a coin as they would say. To date I am still apologizing to my indefatigable president of HEWAN, Chioma.
It so happened that on coming back from Abuja, was caught up and carried away by the twins’ saga which led to the writing of the travelogue on Oshogbo and a reportorial on the Siamese twins that I was by stroke of luck to have delivered through a caesarian section. The story is still ongoing and in no distant time they would be surgically separated in LUTH Idiaraba. I am fervently praying for the success of the operation and would be glad if you’d all join me. It would go a long way towards restoring confidence in our health care system and possible redress in medical tourism that is hemorrhaging the scarce resources of our country. It has never been so bad.
Just when the events at Abuja had slipped into distant memory believing that people must have forgotten about it and moved on, I was rudely awakened. It had come as a phone call from an old friend who told me that he was sending his son, who is a father in his own right from Owerri to see me in Lagos! According to him the young man had lost much weight and very sick. Honestly I felt that based on logistics, that the clinical condition was not worth all the trouble inherent in the journey. Owerri had all the facilities required to meet his health needs. Eventually when the young man came over, the weight loss was obvious; he was coughing and running a fever. There were skin changes and severe shortage of blood in his body. Immediately we ordered for baseline investigations. Preliminary results showed that he is HIV positive and very anaemic.
For me I suddenly realized that it has been quite a while since I saw a stage lll disease of AIDS. It was painful to still see the type of picture that was commonplace in the 80s and 90s in the year 2017. The reality that we could still see florid cases of AIDS was very distracting. This thing is still very much around with us. In all we treated the young man for malaria, transfused him with three pints of blood, commenced him on antibiotics and referred him to Federal Medical Centre, Owerri on the grounds of logistics for further evaluation and recruitment into HAART which stands for highly active anti-retroviral therapy.
The meeting at Abuja was like a big family re-union. Every one that has been involved in the HIV Prevention, Treatment and Care movement was there. Those who couldn’t make it sent in their apologies. It was a time for back patting, handshakes and jollity. The Federal Ministry of Health was fully present and all our Implementing partners, WHO and name it, were all there. The minister of
Health presided during the opening ceremony. In his speech the minister did not mince words when he reminded us of the theme of the conference which is #TEST AND TREAT! Simply put, once a client tests positive, no other criteria is needed before recruiting him\her into ART program.
It would be recalled that previously before commencement of antiretroviral therapy, the evaluation of the clinical condition of the client, the immunological status based on T4 lymphocyte or CD4 count and the number of virions in the blood known as the viral load were needed to determine whether it was time to commence the client on antiretroviral therapy, ART. But now based on the directives of the WHO these are no longer necessary. All that is required for a client to be recruited into ART is a confirmed positive test. And this is very good.
As you’d expect, after the launching of the document for dissemination by the minister; it was time for the technical sessions. This basically involved the presentation of the10 chapters’ document to the plenary session for further discussion. These sessions were very enlightening for more than four days and sometimes far into the night each day. As expected when egg heads gather to discuss and debate, there would always be cross fires. I enjoy that very much. In this outing we would like to concentrate on the Laboratory diagnosis of HIV. This involves the demonstration of ANTIBODIES in the plasma or serum which is the non cellular component of blood. This procedure is referred to as Indirect Testing. The Direct Testing involves the demonstration of the viral nucleic acid in the blood. As a rule with modern technology, HIV antibodies can be detected within four to six weeks after infection and within 24 weeks in all infected persons.
In practice Polymerase Chain Reaction PCR, which is a nucleic acid based test is used to detect the pro-viral DNA in the blood while the Reverse Transcriptase PCR is used to detect viral RNA in the plasma. Don’t bother to understand these jargons until you can appreciate the replication mechanism of the virus in man. However as you must have picked up from your laboratory visits you must have heard about SCREENING and CONFIRMATORY TESTS. These two procedures involve the use of IMMUNO-ASSAYS which is viewing an immune complex from the precipitation of an antigen-antibody reaction through a special light. For the purpose of screening, the RAPID TEST or Enzyme Linked Immunosorbent Assay ELISA is used while in the confirmatory test, the Western Blot and indirect immunofluorescent assay is the norm.
In our environment, there are two types of sequence or ALGORITHM in HIV testing. They are Serial and Parallel algorithms. In the serial algorithm, two different tests are used. If the first test is NEGATIVE, no further test is required, but if is POSITIVE, a second test s conducted using a comparatively less sensitive but more specific test kit based on a different antigen source compared to the first test.
….To be continued