South Africa has an estimated 5.7-million people living with HIV and Aids, more than any other country on Earth. This has had a devastating effect on the mortality rate. Life expectancy at birth in South Africa is down to a dismal 49 years. And one can safely assume that HIV and Aids are major factors in that shocking statistic.
Yet neither HIV nor full-blown Aids are in themselves killers. The cause of death for the majority of HIV-positive patients is a number of opportunistic infections that prove fatal because of the patient’s greatly impaired immune system.
The following is a list of the most common diseases associated with HIV and Aids: bacterial diseases such as tuberculosis mycobacterium avium complex; bacterial pneumonia and septicaemia (blood poisoning); protozoal diseases such as toxoplasmosis, microsporidiosis and cryptosporidiosis; viral diseases such as those caused by cytomegalovirus, herpes simplex and herpes zoster virus; and HIV-associated malignancies such as Kaposi’s sarcoma, lymphoma and squamous cell carcinoma.
Of all the opportunistic infections, however, tuberculosis extracts the heaviest toll. Between 30% and 50% of HIV-positive patients in South Africa die because of TB. What makes TB particularly dangerous is that it is so contagious. The mycobacterium is spread through the airborne droplets, which are produced when an infected person laughs, coughs or sneezes.
The other lethal aspect of TB is its drug-resistant varieties: drug-resistant TB, the multiple drug-resistant strain and now, an even more frightening variety, the extreme drug-resistant TB. These strains have occurred as the result of patients not taking their medication as directed or patients who stop taking their drugs before the full course is completed. It has led the tuberculosis bacteria to mutate, which leads to these strains becoming immune to the original drugs prescribed, making TB far more difficult to treat, hence raising fatality rates.
Another fatal condition associated with HIV and Aids is, of course, pneumonia. In the past 20 years the country has experienced an alarming increase in deaths caused by pneumonia. Between 300 000 and 500 000 citizens become infected every year and between 5% to 10% of them die.
This is something that strains the country’s public-sector healthcare resources because even though HIV-infected patients make up only 10% to 15% of the population, they are responsible for up to 80% of all hospital admissions related to pneumonia.
Other than having the highest HIV and Aids figures in the world, South Africa now, thanks to more enlightened government health policies, also has the largest antiretroviral programme in the world. But, according to World Health Organisation (WHO) measures, access to treatment is still low with only 37% of HIV-infected South Africans receiving ARVs.
With ARV’s, people can live an almost normal life. Because of these drugs, HIV can be regarded as a chronic condition that needs to be managed. A recent international study conducted in Uganda showed that HIV-infected patients on ARVs could live as long as people who are HIV-negative. A research study published by Wits University in May showed that early ARV treatment can reduce the incidence of TB in HIV-infected patients by 40%
In addition to ARVs, there are drugs that have proved to be highly effective prophylactics in preventing a wide range of HIV-related infections.
Called co-trimoxazole (but also known as bactrim), these drugs are cheap and widely available. The WHO guidelines state that they should be prescribed to HIV-exposed babies until the threat of HIV is eliminated. They are also suggested for HIV-positive children, adolescents and adults who have mild, advanced or severe symptoms of HIV.