The Herald (Harare)

Zimbabwe: ARVs Are for Life!

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A concerned workmate asked me recently if it was possible for one to temporarily stop taking ARVs. My response was a strong NO and I queried why he was asking? He narrated to me that on his last visit to his home area of Hurungwe he was constantly reminding his nephew (Mark not his real name), who was on ART, to take his medication. He said he was surprised by his nephew's reluctance who later said he was currently on a break from taking ARVs.

Upon further inquiry the nephew said he had consulted his doctor or health personnel about his decision to stop taking the drugs. The nephew also claimed that his decision was based on the fact that on his previous visit to the local hospital he had been informed by his doctor that his CD4 count had gone up.

My workmate said that he had asked his nephew over again and again and if he was sure.

"I kept asking him whether he had understood what the doctor meant. He said he now was fit enough to stop taking ARVs. In fact, he said: "Chiremba vakati masoja angu awanda zvakanyanya zvekuti ndainge ndofanira kumira kunwa maARV'. (My CD4 count was now back to normal and it was high time I stopped taking ARVs," he said.

By the look on her face, my workmate was deeply concerned about his nephew whom he said had also taken to alcohol.

"Not only has my nephew stopped taking ARVs he is now a heavy drinker which means he could be a danger to himself and his family," he said.

What could have happened with the Hurungwe nephew is that after having gone back to heavy drinking, he occasionally missed taking his dosage, especially the evening ones.

For most people who take ARVs in the morning and later in the evening, the morning dose is not a problem as they would be alert and take their medication when they wake up. It is usually the evening dose which causes challenges to most people especially those who take alcohol. By the time they are due for their evening dose they might be too intoxicated to recall to take them or they might have left them at home. By the time they get home they are too sloshed to remember anything hence they default.

For people who take alcohol in excess it is recommended that they have a drinking mate who knows that they are on ART and will be there to remind them to take their medication.

SafAids in their recent report titled, "Preventing HIV and GBV" noted that men's risk taking behaviour can be worsened by taking excessive alcohol. The report noted that some men may be tempted to stop using condoms when drunk thinking it a sign of bravado when in actual fact it is not. Risk taking is not macho, it is not worth it, even if it appears exciting on occasion.

ARVs suppress the replication of the HIV virus which eventually culminates in a possible return to good health.

ARVs are not meant to eradicate the virus and have never done so. When one takes ARVs as recommended then one's health improves and there can be no apparent signs to show that one has the virus.

When a person defaults in taking ARVs as recommended the virus mutates and replicates. Taking a break from medication is not recommended as this will result in the virus replicating and becoming resistant to line of drugs used to suppress the virus.

The patient will have to be moved to the next line of treatment which is very expensive for the common man. First line drugs are affordable and cost around US$10 a month while the second line regiment costs US$150 a month.

This means that having one patient on second line treatment is equivalent to having 15 patients on first line treatment which is evidently expensive.

Tendai Westerhof, an HIV activist living positively for the last decade, now has an undetectable viral load. This means is she gets tested today, she would test negative.

"I have had an undetectable viral load for the past two years. I still take my ARVs religiously because I have to. ART is for life and this new lease of life can see me live 30 to 40 years since I started medication.

"I have had problems with people who said that they are now on ART break since their CD4 count had gone up.

"One's CD4 count going up is a sign that the ARVs are working well, but should never be used as a measure to stop ART," she said.

Some people have stopped taking ARVs after having undergone healing sessions.

"Healing, I have healed," said Westerhof during a workshop in Kadoma.

The audience went aagh and she went on to say: "I have been healed because the HIV virus no longer causes any illness in me. I am in charge of my life now as I take my ARVs without fail and pray. Prayer is complementary to ART, so I can declare I am healed," she said.

It is important for all those taking the drugs to know that once you have started on the programme one has to take them for life. Failure to do so would be disastrous for both the individual and the country.

Once one stops taking the drugs, the virus mutates and become resistant to the drugs meaning one has to take a new combination of drugs.

If he was on line one drugs and decides to take a break, it is most likely that he will be put on line two drugs. These are expensive and thus cost the country more.

In most unfortunate circumstances one can develop complications that can even lead to death hence it is always advisable to stick treatment regime.

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