December 1sthas been commemorated as international world AIDS day since 1988. It is dedicated to raise awareness on the HIV pandemic and remember those we have lost to the battle.
Seeing the AIDS acronym and word ‘cancer’ side by side represents a reality that a significant number of people have to live with everyday. However, one hopes as the stigma attached to both health challenges dissipates with each passing year to make the journey for our family and friends much easier.
HIV infection can be present in anyone from birth. This is because the virus can be transmitted from a mother to her developing foetus. If a pregnant woman neglects to test for HIV and take antiretroviral drugs, the virus multiplies to the millions and can be passed on through vertical transmission. On the other hand if a woman compliant and has a viral load that is suppressed the chances that she will give birth to a HIV negative baby are high. The same goes for transmission horizontally to sexual partners.
As you may well know the symptoms of HIV infection in the initial phase are very subtle. They can be flu like symptoms or a very short period of enlargement of glands called lymph nodes, which are easily felt along the neck, in the armpits and groin area. Honestly speaking the symptoms are so non-specific that only a conscious mind knowing your exposure risk and attending testing will help you establish a diagnosis. These symptoms are a signal your body is fighting off disease. This stage is vital because it presents an opportunity for prevention by taking antiretrovirals within 72 hours of exposure.
After that everything quietens down if you have not sought intervention. This is not good as it indicates that the virus has managed to muffle your immune system and sets to work destroying it by systematically infecting and killing CD4 cells. This phase can last up to ten years and at this point you are highly contagious.
Once the immune system is sufficiently weakened phase three begins where bugs that you ordinarily could fend off have a field day using your body as a food source. It is characterised by rashes, flus, coughs and diarrhoea. Weight loss compounds the bleak outlook. Even at this point commencement of medication could save one’s life.
AIDS, which stands for Acquired Immune Deficiency Syndrome, is an advanced stage of HIV infection where the body’s defences are weakened to a life threatening point. It is also promotes an environment for cancers to thrive. Some cancers are termed as AIDS defining. This means that they push HIV infection into an official crisis for the body. Others are associated meaning they are frequently present in people infected with the HIV.
The paradigm of HIV infection and cancer has shifted due to effective treatment with antiretrovirals. This allows people living with HIV to have immune competent systems for many years circumventing the threat of opportunistic infections and AIDS defining cancers. Such an example is Epidemic Kaposi’s Sarcoma where disease progression is rarely noted if the viral load is suppressed and CD4 count reasonable.
Cervical cancer unfortunately doesn’t enjoy the same direct benefit. This may be associated with the fact that chronic HPV infection may have generated mutated cells before ARVs are commenced. In the new test and treat era we may see a difference. In the same breath good screening programs still see a high prevention rate in this population of women in terms of catching cancerous prone cells early.
The association of developing some of cancers in HIV infection can be easily seen when one takes in to consideration that infection with multiple viruses can occur at the same time. These include lymphomas, anal cancer, and liver cancer.
There is a need to say not everyone with cancers that falls in the category of HIV/AIDS-associated are infected. The stigma that surrounds the issues can be demoralising for the patients. The hope is speaking out on issues like this breaks the cycle of shame associated with either condition. The knowledge we provide is not for us to know ‘utuntu’ so we can effectively point fingers and gossip. On the contrary it is for us to know ‘utuntu’ so that we can stand up for those who find themselves without a voice.
Accepting to be tested for HIV when diagnosed with cancer is a good idea because it is well known that cancer treatment affects the body’s immunity. This compromise is entered into because the benefit is overwhelming compared to the risk if managed well.
In cervical cancer for example one’s status doesn’t prevent them from receiving the standard of care but it helps out watch out for any danger signs. For liver cancer the treatment of the probable causative virus may overlap with ARV regimen and it is useful to know this.
In many ways these two terrible diseases are entirely preventable, treatable and beatable. The key is applying our knowledge. Whichever stage you are at as an individual take a bold step.
‘Be on guard. Stand firm in the faith. Be courageous. Be strong’ 1 Corinthians 16:13.