HIV and Chronic Diseases in Developing World

Chronic Diseases and HIV, a growing relationship?

As more and more people get access to HIV treatment drugs, more patients are moving from being terminal to having it as a chronic illness related disease. Gone are the days when HIV was viewed as a death sentence for most people in Zimbabwe, rather the norm is now the saying " if you get HIV, get your pills and go on living" .  However, will this is an obvious success in the thinking of the people, according to K M Venkat Narayan and Sten Vermund,
"Chronic disease among HIV positive people has been overlooked"

People worldwide are living with HIV. Massive global efforts and investments to deliver combination antiretroviral therapy (ART) have transformed a fatal infectious disease into a chronic, treatable disease. HIV-infected people who comply with ART now have near-normal lifespans — but as a result they may face the new threat of chronic noncommunicable diseases (NCDs). Stress, stigma, aging and HIV-related inflammatory changes increase the risk of some cancers as well as diabetes, heart disease, stroke, chronic kidney disease and mental health problems.

The huge gains made from implementing ART globally — 13 million people now get this treatment, nearly 90 per cent of whom live in low- and middle-income countries (LMICs) — will be lost unless the rise of NCDs in HIV survivors is addressed. High-income nations have been tackling this challenge since 1996, and it is time to do the same in LMICs too. .......Some studies have suggested that certain ART treatments may increase the risk of diabetes. There are also concerns about how ARTs may interact with drugs commonly used to manage NCDs. Some conditions, such as infectious myocarditis and other heart conditions associated with opportunistic infections, may be of special concern in countries where the prevalence of infectious disease, malnutrition and other poverty-related conditions is relatively high. 

But a more important question is this: how must effective systems be developed to deal with NCDs among HIV survivors in regions facing severe resource constraints? ( for more .....http://www.scidev.net/global/hiv-aids/opinion/research-agenda-hiv-survivors.html

Africa

Chronic non communicable diseases,a challenge for the African Region.

The increasing burden of noncommunicable diseases (NCD) , particularly in the WHO African Region, threatens to overwhelm already over-stretched health services. The risk factors underlying the major chronic non communicable diseases which are; cardiovacular diseases, diabetes, cancer and chronic respiratory conditions are well documented. The known risk factors are unhealthy diet, physical inactivity, alcohol consumption and smoking. Primary prevention based on comprehensive population-based programmes is the most cost-effective approach to contain this emerging epidemic. ...http://www.afro.who.int/en/zimbabwe/zimbabwe-publications/1074-chronic-non-communicable-diseasesa-challenge-for-the-african-region.html

Zimbabwe

HEALTH and Child Care deputy minister Paul Chimedza last week disclosed that non-communicable diseases such as cardiovascular, cancer, mental health, diabetes mellitus and chronic respiratory complications had now become the country’s main killers ahead of HIV and Aids

According to the World Health Organisation (WHO) non-communicable diseases were a group of conditions that included cardiovascular diseases, cancer, mental health problems, diabetes mellitus, chronic respiratory diseases and musculoskeletal conditions.

WHO said non-communicable diseases were silent killers, had insidious onset, debilitating complications and resulted in painful deaths, adding the number of chronic disease-related deaths in the WHO African region in 2005 was close to 2,5 million people.

“WHO projects that 28 million people in the region will die from a chronic disease over the next 10 years. The rate of increase of deaths from chronic diseases will outstrip that from infectious diseases, maternal and peri-natal conditions and nutritional deficiencies more than four fold in the next 10 years.”

The Population Reference Bureau (2012) said in Zimbabwe, 21% of deaths were due to non-communicable diseases.

(https://www.newsday.co.zw/2014/04/07/non-communicable-diseases-surpass-aids-main-killer/)

Zimbabwe: Making HIV an ‘undetectable’ virus

Fernando Fidelis/MSF

MoH staff collecting blood for viral load test.

The latest generation of HIV medical technology is making breakthroughs in care for HIV-positive patients, and in containing the epidemic in many African countries. The latest blood test, known as the viral load test, offers patients hope for a future free from the possible complications triggered by the virus. During 2013 Médecins Sans Frontières (MSF) performed the test on around 30,000 patients in Zimbabwe.

“We collect blood samples of 3–5 ml from patients at the different health centres. We then take them in the MSF four-wheel drive to the laboratory where the specialised staff prepare the samples to be sent to South Africa where they will be analysed,” explains Susana Villen, a doctor from Zaragoza, who has recently returned to Spain after spending more than two years in Zimbabwe as medical coordinator of MSF’s HIV project in Tsholotsho. “Monitoring HIV patients is fundamental for controlling their health, as well as the epidemic itself. It is important to know if the medication is working or not, how effective it is for the patient and against the virus.”...

“In Tsholotsho, despite the high cost of testing, we managed to test the viral load of nearly all our patients. We wanted to make sure we were giving them the best treatment. After doing the tests on many patients, we prescribed new drugs with fewer side effects. It was a breakthrough for patients in the area, especially for adolescents, since we were having a lot of problems of treatment adherence among this group. When an adolescent has no health problems, is not affected by any opportunistic disease, and yet his viral load is very high, we see that is a problem of adhesion. Knowing this allows us to act and fix it,” says Villen.The CD4 test counts the lymphocytes (cells that activate a person’s immune system against the presence of infections or cancers), but can only indirectly indicate the progression of the disease by identifying the number of defences generated by the immune system. The new technology transforms HIV into a chronic disease, like ailments like diabetes or high blood pressure, and can help people with HIV to live a long and healthy life....http://www.msf.org/article/zimbabwe-making-hiv-%E2%80%98undetectable%E2%80%99-virus

Some resources on Zimbabwe, chronic diseases and HIV

Zimbabwe health statistics profile 2010 link http://www.aho.afro.who.int/profiles_information/images/7/78/Zimbabwe-Statistical_Overview.pdf?ua=1&ua=1

Zimbabwe statistics health factsheet
http://www.aho.afro.who.int/profiles_information/images/0/0c/Zimbabwe-Statistical_Factsheet.pdf?ua=1&ua=1

action framework for prevention and control of chronic disease
http://www.afro.who.int/en/downloads/doc_download/6880-action-framework-for-the-prevention-and-control-of-chronic-diseases.html