Guyana Chronicle
November 27, 2002

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Acquired Immune Deficiency Syndrome (AIDS), spreading unobserved since the late 1970s, was not clinically identified until 1981, when the Centres for Disease Control and Prevention (CDC) published a paper in Morbidity and Mortality Weekly Report, relating abnormal clusters of opportunistic diseases among homosexual men in New York and California.

In 2002, the sustained impact of Human Immunodeficiency Virus (HIV) has devastated large parts of the world and compromised and stigmatised millions living with this dreadful disease. At the end of 2001, globally, the number of people living with HIV/AIDS was 40 million, with adults 37.1 million, women 18.5 million and children less than 15 years 3 million. AIDS deaths worldwide at the end of 2001 totaled 3 million.

In Guyana, at the end of 2001, adults and children living with HIV/AIDS were 18,000, adults (aged 15-49) 17,000 women (aged 15-49) 8,500 and children (aged 0-14) 800. AIDS deaths in Guyana for 2001 for both adults and children were 1,300.

With currently no cure for HIV/AIDS, prevention intervention, care and treatment, and impact alleviation must incorporate some strategic components of any plan aimed at addressing the problem. For those stricken with the virus, affordable treatment and care become imperative. Guyana has led the way in providing treatment for HIV. But before we expand on Guyana’s leadership in this respect, let us briefly examine the pathogenesis of HIV.

The HIV infection destroys the immune system through disabling and killing the immune cells called CD4+ T cells. A person without the HIV infection would normally have 800 to 1,200 CD4+ T cells per cubic millimeter (mm3) of blood. However, when a person’s CD4+ T cell count drops below 200 cubic millimeter of blood, the person becomes vulnerable to opportunistic infections and cancers that characterize AIDS.

HIV comes from a group of viruses called retroviruses, having genes made up of ribonucleic acid (RNA). Humans have genes made up of deoxyribonucleic acid (DNA). The HIV can only reproduce itself inside cells. So when the virus enters the immune cell, it utilizes an enzyme known as reverse transcriptase to transform the RNA to DNA. This conversion becomes included in the person’s genes that compose the cells.

Currently, scientists are developing drugs to make people living with HIV/AIDS live longer, and strenuously pushing to develop a cure. At this time, people living with the HIV infection have to use antiretroviral medicines. Antiretrovirals slow the progression of HIV to a full-blown AIDS condition.

The antiretroviral drugs prevent the virus from reproducing itself. Unfortunately, antiretroviral drugs do not destroy the virus. Three types of these drugs are available: the first is the Nucleoside Reverse Transcriptase Inhibitors (NRTIs). These Inhibitors block an HIV enzyme called reverse transcriptase that facilitates the virus to reproduce itself. The second is the Non- Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). These block the reverse transcriptase differently from enabling HIV from making copies of itself. The third is the Protease Inhibitors. These stop an HIV enzyme called protease which the virus uses to reproduce itself.

It should be noted that these three kinds of drugs may stop HIV from reproducing itself. The medicines have greater efficacy when used together. When the medicines are combined for usage, they are referred to as ‘cocktails’ or ‘combination therapy’ or Highly Active Antiretroviral Therapy (HAART). Clearly, one drug may not do the job. The antiretroviral medicines attempt to keep the viral load low, and the CD4 T cell count high. The viral load is the amount of HIV in the blood. The CD 4 count tells how well the body is combating the HIV infection.

Again, the antiretroviral drugs are quite expensive and outside the reach of the poor with HIV infection. However, Guyana through the New Guyana Pharmaceutical Corporation (New GPC) is the only manufacturer of antiretroviral drugs in the Caribbean. The New GPC now manufactures 10 antiretroviral drugs, three of which are combination therapies. The Ministry of Health purchases the 10 antiretrovirals from the New GPC.

The former GPC was divested by the Government of Guyana. The majority shares were bought by Queens Atlantic Investment, Inc. Its chairman Dr. Ranjisinghi Ramroop disclosed that a sum of US$1.6M is being invested for plant modernization, quality control improvements, and Research and Development.

The New GPC’s antiretroviral drugs have been approved by the Government Analyst's Department.

As we approach another World AIDS Day on December 1, let us focus on the fact that HIV infection is preventable, mainly via behavior change. The agencies tasked with fighting HIV/AIDS, must understand the factors that influence behavior and behavior change. The National AIDS Program Secretariat needs to lead the way in designing behavioral intervention programs, incorporating best practices in prevention. The vulnerable populations, in addition to their participation prevention intervention programs, also must be encouraged through appropriate pre-test and post-test counseling protocols to present themselves for HIV testing. Guyana already has too many HIV-Positives in its population, largely due to high-risk sexual behaviors.

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