Guyana set to expand quality HIV treatment
CD4 machines installed
Stabroek News
June 11, 2004
The Ministry of Health is now in possession of two CD4 FACS Count machines which will facilitate better management of HIV patients by testing for the presence of a key immune system cell.
The ministry and its partners, the US Centres for Disease Control and the Francois-Xavier Bagnoud Centre (FXBC) at the University of Medicine and Dentistry of New Jersey, launched the machines at Le Meridien Pegasus Hotel on Wednesday.
The CD4 cell count machines, which are now at the Central Medical Laboratory at the Georgetown Public Hospital Corporation (GPHC), were made available by the United States Government, under the President's Emergency Plan for AIDS Relief (PEPFAR).
Minister of Health Dr Leslie Ramsammy, described the launching as another significant milestone in the country's fight against the virus since it ensures a more comprehensive response to HIV/AIDS. He said the availability of CD4 count tests will now provide the opportunity to expand the criteria for eligibility to the country's treatment programme.
Initially, tests will only be available at the Georgetown Hospital for free. But the minister said that public health facilities offering treatment will be able to make arrangements for their clients to get CD4 testing without going to the Georgetown Hospital and private sector clients can also make arrangements. The minister encouraged doctors in the private sector to engage his ministry to work out the modalities.
"Again as with ARV (anti-retroviral drugs) we will ensure that no one who needs CD4 testing will be deprived of it," Ramsammy said. "But as with ARVs there will be strict protocols. It is not necessary to have to test everyday for CD4 but the temptation for somebody living with HIV/AIDS will be to be tested as often as possible. The protocol will advise on how often someone needs [to be tested] and under what circumstances persons should be tested."
He said the protocol would be widely publicised in both sectors.
Bold steps
National AIDS Pro-gramme Director, Dr Morris Edwards giving a history of Guyana's HIV treatment programme said that at the end of last month some 360 persons were being treated with anti-retroviral drugs. But, he said, "I would be the first to admit that this is a small drop in the ocean as it is estimated that 6,000 persons need treatment," he said.
He said the burning question has been why only such a small number of people are being treated in the public sector. According to him, the major reason is the absence of laboratory technology to determine the optimal time for infected persons to be placed on treatment.
According to him, the CD4 count test is universally accepted as being more important than viral load testing. However, if both are accessed then it would be better. "Commissioning of the two CD4 count machines in Guyana today is therefore of great significance."
He noted that the country's treatment programme could now be supported by state-of-the-art technology bringing the country's programme to the standard recognised worldwide.
As soon as a person tests positive for the virus a CD4 count will be done to determine whether the person needs to commence treatment, and Dr Edwards said it is hoped that this will encourage infected persons to access treatment.
According to him, the women in the country's Prevention of Mother to Child Transmission Programme (PMTCT) who tested positive and were not able to access treatment because they did not know if they needed it, will now be able to know this and access the treatment. And this will also be extended to their partners and children if they test positive.
"[The CD4 count will enable us]...to objectively monitor patient response to treatment, previously we were using the subjective measurement of a person's clinical improvement. That is where we were. We have to creep before we walk and we are now taking the bold step and standing on our feet."
He said the availability of the CD4 count could act as a stimulus for research on the normal range of the CD4 count of the Guyanese population and therefore set the benchmark for initiating treatment. The research can also help in understanding the Guyanese response to the treatment.
The CD4 testing is used to monitor and provide reliable information on the immunological status of HIV-infected patients and with this testing HIV-infected persons can be monitored and cared for using state-of the art measures which provide a more comprehensive and accurate view of HIV disease progression.
The CD4 count and HIV viral load are said to be the best indicators for clinical progression of HIV.
By monitoring CD4 count, it is possible to assess the weakening of immune system and determine whether ARVs are working to control the virus.
What are
CD4 cells?
CD4 cells are a type of white blood cell, or lymphocyte, that coordinates the immune system's response to certain micro organisms and viruses. As the HIV viral load increases in the body, HIV kills the CD4 cells, and causes the CD4 count to drop.
Normal CD4 count in the healthy persons is:
Men: 500-1200 cells/millimetre (mm)
Women: 500-1500 cells/mm
Children age 5 and younger: 900-2800 cells/mm
The CD4 count falls by approximately 60-100 cells per year in HIV-infected people.
A CD4 count of less than 500 indicates that the immune system is being damaged and when the CD4 count remains above 200, the risk of developing some opportunistic infections is not high.
A count below 200 suggests increased risk of contracting serious, life threatening infections and this is when medicine to prevent infections are given and ARV treatment should be started.
CD4 testing:
The CD4 count is measured by taking a small sample of blood (a cubic millimetre, or mm).
CD4 test results assist in starting and managing anti-retroviral therapy and prophylaxis for opportunistic infections.
It also counts the rise and fall, due to a variety of factors such as colds and flu, smoking, seasonal changes, menstrual cycles, major surgeries and when taking steroid medication.
CD4 count and treatment:
One should do a CD4 test before treatment begins and at least every six months. If the results show a fall in the CD4 count in the absence of illness, it may be necessary to repeat testing more often.
CD4 counts are used to monitor success of ARV treatment and if counts should rise sharply in the first year of ARV treatment, and then continue to rise slowly and steadily the treatment is controlling HIV.
If the treatment is not working, the CD4 count will fail to rise and continue to fall.
PLWHAs
A representative from the Guyanese Network of People Living with HIV/AIDS (G+) noted that the timeliness of the two machines could not be over emphasized. Speaking at the launching the woman said without access to such facilities, persons living with the virus were forced to endure extreme difficulties in accessing accurate information regarding their health since many of them could not afford the cost of the service offered privately and overseas.
"The advent … of this equipment within the Georgetown Public Hospital Corporation where access will be free of cost, will bring considerable relief within the PLWHA [People Living With HIV/AIDS], community. For instance PLWHAs will be better managed in terms of knowing the precise time to commence treatment..."
FXBC
Meanwhile, Guyana's newest partner FXBC is dedicated to improving the lives of vulnerable families including those families infected and affected by HIV infection. It reaches across traditional boundaries to expand expertise in research and global health while continuing to link research and practice through education. The centre, according to a brochure, provides clinical care, education, and conducts research. Its mission is to expand health and supportive services that improve the quality of life for children and families with chronic illnesses including HIV infection in the United States and globally. (Samantha Alleyne)