New hope for HIV/AIDS patients
By Shirley Thomas
Guyana Chronicle
December 7, 2002

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Guyana has moved yet another step forward in the fight against HIV/AIDS.

This time it's with the acquisition of laboratory testing facilities that will be able to count or measure the amount of CD4+cells in persons with the HIV virus or with opportunistic infections such as malaria, tuberculosis or Socially Transmitted Infections (STIs). The CD4+ cells (also called T- cells), are helper cells, which lead the attack against infection in the body. Hence, the CD4+ cell count is a key measure of the immune system.

In effect, the amount of CD4+ cells in the blood of a person with the HIV virus, will give an indication of that person's viral load (how much of the HIV virus) in the system, and the extent to which it has destroyed the immune system.

A person's immune system is that system which fights against disease invasion in the body.

Outlining the benefits of the facility, Minister of Health Leslie Ramsammy yesterday said: "This machine, by allowing us to do CD4 has now advanced the whole area of Treatment and Care, since now that we are treating people, we can now begin to monitor them to see how they are recovering."

The more CD4+ cells there is in a person's body, means that the less destruction of the immune system has taken place, or one may say - the lower or weaker the viral load (referring to the HIV virus in the system.)

Through the setting up of "Multi-Tech Reference Laboratory", a privately owned facility at Lot 8 Cove and John, East Coast Demerara, and a satellite lab at 77 Winter Place and Brickdam, Georgetown, persons can now have their CD4 and even CD8 and CD3 T Lymphocytes in the blood tested.

The service was formally introduced yesterday when Director, Mr. Erroll Bassoo, a Canadian-based Guyanese took members of the media and others on a tour of his Brickdam facility.

Bassoo said that the tests will be assayed on the BECTON-DICKINSON's FACSCOUNT SYSTEM.

Bassoo who will be providing the service at a cost, explained that when HIV infects humans, the cells it infects most often are the CD4+ cells, which are a key measure of the immune system.

The CD4+cells are also used to indicate when to start certain types of drug therapy. This count will also tell the physician whether the drug is helping the HIV infected patients, Bassoo said.

Minister of Health, Dr. Leslie Ramsammy was among those who addressed the gathering assembled for the ceremony.

Noting that the technology is the first of its kind in Guyana, Minister Ramsammy said that the introduction of the facility into the Guyanese society is indeed a breakthrough.

Previously, he said, Guyanese could have done their CD4 tests in Trinidad, where the cost would have been approximately US$150-$175. But Minister Ramsammy said he will be initiating for the public sector here to access the facility at Multi-Tech Reference Laboratory at a much lower cost - maybe US$50.

Dr. Ramsammy said that in the case of HIV/AIDS, there are two aspects to the testing. Firstly, when someone is diagnosed HIV positive, "we need an indication as to how that person's immune system is being destroyed by HIV... " Noting that in such a case, the person becomes susceptible to a number of diseases, he said that in cases where there are diseases that the immune system cannot fight, those diseases will eventually take a toll against the person's body. "In the case of HIV it will take a rapid toll," he added.

The Minister admitted that, previously, the Ministry of Health in Guyana used no scientific method of determining the person's viral load before commencing treatment with antiretrovirals. He said that what was taken into consideration was - that the person having tested HIV positive, and having developed an opportunistic infection, gives us an indication that the person's immune status has now dropped - probably to a CD4 of under 200."

The Minister explained that a normal healthy person would have a CD4 range as high as 1000. Notwithstanding, Dr. Ramsammy said, there are some persons who are not HIV positive, but have a CD4 count of about 600. A count of 200 and under, signals a weakened immune system.

"What we are doing up to now, without the availability of the test, is to use the presence of the disease as an indication of HIV now having severe effect on the immune response".

Dr. Ramsammy further explained that once the person goes on antiretroviral drugs, the physician will want an indication as to whether the drug is indeed causing a restoration of the immune system.

Meanwhile, in an earlier interview with the Chronicle, University of the West Indies Lecturer in Clinical Medicine and Research, and Consultant Physician and Blood Specialist at the Barbados HIV/AIDS Referral Centre, Dr. Akin Abayomi also reemphasized the benefits of conducting CD4 tests before commencing treatment of persons with the HIV.

Said Dr. Abayomi: “If you are going to treat HIV, you have got to do it properly, otherwise you are going to run into problems with resistance.”

He stated categorically: “Not every patient tested positive gets treated with the cocktail of drugs or the Highly Active Antiretroviral Therapy (HAART) - usually three drugs.”

“We operate within certain international guidelines,” he stated, adding:

“We do not start treating until there is a certain amount of the virus in the body, and the immune system has suffered a certain amount of damage.”

This is so too, he said, since:
The viruses can develop resistance very quickly

These drugs have their own side effects.
“So we feel it is best to leave the patients while thy remain well, until a certain point before we start treatment and we are hopeful that with treatment, virus burden in the body will decrease,” Abayomi stated.

And Dr. Ramsammy yesterday, concurred that patients being tested for CD4 cells should be monitored.

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