“There are still one million people dying of HIV despite the scaling up of antiretroviral (ARV) treatment in low and middle-income countries,” Dr Graeme Meintjes told the International Congress on Infectious Diseases in Cape Town.
He said the rate of Aids deaths globally had decreased from 2.3 million in 2005 to 1.6m in 2012, 1.2m of which were in Africa.
Most of these people were young adults who had left huge gaps in their community.
From a programme point of view, most African treatment systems were “overstretched, understaffed and had many cracks”.
Testing for the virus in its early stages was sub-optimal in coverage and many people only started ARV therapy when they had very low CD4 counts (the count of white blood cells that fight infection).
Based on a 2009 study, Meintjes said those in high-income countries were given ARVs when their CD4 count was around 274 cells per microlitre.
In low-income countries, this treatment started when the CD4 count was around 145 cells per microlitre.
Those with a count lower than 200 had the greatest risk of developing opportunistic infections. He said drop-out rates in treatment programmes were high.
“By three years on ARVs, a third of the people are lost to the programme,” Meintjes said.
Many of those lost returned a year or two later with an Aids-defined illness.
“Up to half of the deaths in HIV are attributed to tuberculosis (TB),” he said.
A study on 39 organ biopsies at a Johannesburg hospital showed that most deaths were due to disseminated TB, which spread from the lungs to other body parts through the blood or lymph system.
Meintjes said an increasing concern was drug-resistant TB, which was diagnosed in 15,000 people annually and had a high mortality rate.
Other major clinical conditions found in those who had died while on ARVs were bacterial and fungal infections, and Kaposi’s Sarcoma, a connective tissue cancer.
Meintjes said there were interventions available to counter these ARV problems. Health facilities should have user-friendly HIV services so that people felt comfortable going there for the rest of their life.
Technology like cellphone messaging should be used to send information to patients and remind them of appointments.
The congress at the Cape Town International Convention Centre was organised by the International Society for Infectious Diseases, in collaboration with the Federation of Infectious Diseases Societies of Southern Africa.