Special Treatment Situations

Tuberculosis

Tuberculosis was treated in harmony with the National TB program and several cases of TB as part of an immune recovery syndrome occurred. Sputum smear negative cases and extrapulomonary tuberculosis (lymphadenopathia) were a common experience which goes well together with research findings from Tanzania .
To our feeling it was a common clinical lesson that TB was underestimated in PLWHA at the beginning and in the course of the project’s time we started to consider and to treat TB more aggressively, several patients taking antiretroviral drugs and TB drugs at the same time recovered well.
There was no INH prophylaxis done.


Side effects

For the first year there was rarely a problem with side effects, we only had three cases of NVP skin problems which needed a switch to Efavirenz in two cases due to the development towards Steven Johnson Syndrome.
No case of clinical suspicious lactic acidosis occurred in the first year but it is to fear that some patients especially those women put on ARVs (PMTCT plus) because of pregnancy and higher cd4 levels will develop this problem.
Lipodystrophy started to become a problem during the recent months but it is not reported that any patient has switched drugs yet.
The CTC/HAART team started to think about these unavoidable future treatment situations and had already taken efforts to be prepared . There is a vast experience from other countries using the Tanzanian regimens since years and have nowadays changed away from most of the d4T based regimens. This is a normal process and nothing special at all, but teams have to be prepared in time and challenging situations have to be dealt with by experienced staff. These are challenging future situations and the programme had started to prepare for them with suppliers, manufacturers (like Partec in Germany and Action Medeor) and colleagues from abroad (Austria, Canada, Thailand) who were willing to help through their expertise by direct and Internet consultancy.
Likely this year, the issue of Stavudine (d4T) like lipodystrophy and lactic acidosis will be especially pressing and could become life threatening for patients who are not properly monitored. It is well known that for effective long term care a stable mutual relationship between doctor and patient is essential in order to succeed treatment marathon. This relationship has been destroyed by the responsible Elites in the church.



 
Children and Pregnant Women

About 10 children were put on ARV drugs and monitored generally with good success, though for some very young ones the treatment came late and they died.
Fellow children turned out to be very good watchdogs for health care workers and excellent adherence counselors and care givers for other children. They were very thoroughly watching drug intake in their peer group and made sure that the clinic schedules were kept, Children did even the job to be the treatment advocate for an elderly very well .
Syrup and Tablets were used according the recommendation of the National AIDS control program and special computerized sheets were prepared to make sure the right dosing of the drugs.
We think that there is no right to deny any child in the world antiretroviral treatment!
Bulongwa was the first site in Tanzania being able to do direct determination of cd4% for the high quality Antiretroviral Treatment of Children .


Pregnant Women and Prevention of Mother to Child Transmission

Pregnant women were given Nevirapine by the hospital through an AMREF program but we were very keen in doing PMTCT plus and did so with several woman. The life of these women on ARVs is now in danger as nobody is knowledgeable and promoting planned treatment interruption. Especially this group is in an especially high risk of developing lactic acidosis.
We consider Prevention of Mother to Child Transmissions by a single Drug obsolete and it is not done for a child of Elites or Do-Gooders at any place in the world.
Why for the Have Nots? We think the best way of prevention would be good enough for every pregnant HIV Positive women in the world. This is very possible.