Sunday, September 22, 2013

Cayman's doctor on adult diseases Dr Olayinka A Adedayo has said that despite numerous technological breakthroughs in the fight against HIV, the country's government has been left to bear the healthcare cost of the infection that is indifferent to most insurance companies.

In an exclusive release to Cayman Net News ahead of his national presentation about the HIV disease, Dr Olayinka noted that government has been forced to bear most of the cost. This is so because of stigmatisation of the disease, which means that most of the information is never public.

"The average healthcare cost of HIV treatment is astronomical due to cost of drugs. The newer one tablet /day polypills needed for treatment are very cost prohibitive with one month's supply cost ranging from $1,900-$2,500," he stated.

"The once a day polypill "Atripla" now used in most good centres in medically advanced countries as the starting medication for HIV care has being in use in Cayman Islands since 2009.

"The global funding for HIV care by most foundations mostly go to underdeveloped and developing nations which excludes most Carribean states, thus leaving the burden of HIV care to government financing solely.

"With current changes in global economy and the rising cost of healthcare, the leading role of HIV control through excellent care that Cayman enjoys may also be threatened without involvement of private organisations.

The Bill Gates and Bill Clinton did a lot for HIV funding," he said in the press release.

"It's time for private organisations and industries to support Cayman AIDS foundation to achieve a shared United nations vision of zero new infection, zero discrimination and zero AIDS related death. A world without AIDS," Dr Olayinka stated.

Below is the text of his statement on HIV/AIDS: Over the last 30 years, a lot of advances in science and medicine have made significant and dramatic progress in HIV/AIDS since inception. HIV/AIDS started as a mysterious disease of obscure aetiology that resulted in definite death, public discrimination and social isolation. Today, we have made significant inroad to understand a disease that is now completely controlled and very close to a permanent cure, a rallying point of love and compassion, global demonstration of solidarity and a clear hope of a world without HIV/AIDS. HIV/AIDS was initially described in 1981 IN New York and Los Angeles when an abnormal clustering of a very rare vascular tumour called Kaposi's Sarcoma was seen in middle aged homosexual men that were mostly whites. They all had complications of other infections not normally seen in healthy people with a competent immune system such as pnemocystis pneumonia [a rare pneumonia],brain toxoplasmosis [brain parasite], cryptococcal meningitis [brain fungal infection], extensive Candida infection, incurable herpes and others. It spread like a wildfire and in a few years became a worldwide pandemic with presence in every region of the world. Today over 34 million still live with HIV/AIDS and over 35 million deaths since the description of the first case. There are about 7,000 new infections daily worldwide. The Center for Disease Control, Atlanta announced the emergence of this strange disease and called it "Acquired Immunodeficiency disease [AIDS] due to the overwhelming loss of immune ability in afflicted individuals who are subsequently prone to life threatening infections and cancers. Prior to this, it was called "GRID", gay-related immune-deficiency disease," and the "4H Disease", referring to homosexuals, haemophiliacs, Haitians and heroin users. By 1982, it was clear that though it initially occurred more in homosexuals, it also afflicted heterosexuals, new born infants, recipients of blood products and IV heroin users suggesting a transmissible infectious aetiology. The infective cause was identified in 1983/1984 through the combined efforts of scientists at the Louis Pasteur Institute in Paris and National Cancer Institute in USA. A lot of time was lost initially through back and forth on the origin of this mysterious disease, which allowed it to spread further worldwide. Out of all the theories advanced as its etiology, "the bush meat hunter theory" was the most accepted. The "bush meat hunter theory" suggests that a similar virus lived for years in Chimpanzees in Central Africa. A bush meat hunter might have being infected possibly during butchering of a chimpanzee with a variant of same virus that eventually proved very pathogenic to man, lived in man and could not be eradicated. By the year 1983, the AIDS hysteria became worldwide and there were reports of landlords in New York evicting AIDS patients from their homes. This reached a new height in 1985 when the world was shocked with the case of Ryan White, a teenage boy from Kukomo in Indiana, with haemophilia but HIV infected during transfusion. He was ejected from school because of his HIV status. Though given 6 months to live, he lived for 5 more years becoming the strongest advocate for this new challenge and became the face of HIV/AIDS in American posters. There was further attention when American celebrity and Hollywood star collapsed in an hotel in Paris on 21st July 1985 and was later declared to be having AIDS. He died in October 1985 but prior to his death he stated that, "I am not happy that I am sick. I am not happy that I have AIDS, but if that is helping others I can at least know that my own misfortune had some positive worth. William M Huffman [artist/author] stated "If Rock Hudson can have it, nice people can have it, it's just a disease." Rock Hudson died in October 1985 and after his death, Morgan Fairchild stated: "Rock Hudson's death gave AIDS a face." Other celebrities who succumbed to AIDS included Michael Bennett [American musical director], Freddie Mercury [British musician], Arthur Ashe [World Tennis No.1 player], Liberace [a former highest paid entertainer in the world],Tina Chow [model,jewelry designer,influential fashion icon] etc. The global response became massive after the death of Rock Hudson, which included the launching of the American Foundation for AIDS Research co-chaired by long time associate of Rock Hudson, Elizabeth Taylor. Former US president George Bush Jr. in the largest healthcare funding in history launched "PEPFAR" [Presidents Emergency Plan for AIDS relief] with an initial $15 billion dollars over 5 years towards prevention, diagnosis and treatment of HIV/AIDS especially in Sub-Sahara Africa. The PEPFAR project averted about 1.1 million deaths from HIV/AIDS in Africa. The other major contributors to HIV/AIDS financing were Bill and Melinda Gates foundation, former president Bill Clinton health access initiative through the Bill Clinton Foundation, which aimed at tripling the number of people receiving anti-retroviral treatment in South Africa and provides funds for large scale treatment. The Ryan White act was enacted in 1990 as a Public health service act [XXV1]-HIV/AIDS-1990. The programme makes US federal government funds available to assist in healthcare costs and support services for individuals and families affected by HIV/AIDS. The funds mostly went to low income, un-insured and under insured people. In October 2009,President Obama signed the Ryan White HIV/AIDS treatment extension act,2009. The first drug introduced for treatment in 1987 was Zidovudine [AZT] as monotherapy, but was a failure due to development of resistance after a few years though it reduced maternal to child transmission by 30 per cent. However in 1995, combination treatment with at least three different drugs were introduced, and this opened a new chapter in HIV care as death due to AIDS was reduced by as much as 25 per cent. Combination therapy resulted in undetectable virus in the blood, but a new challenge emerged, there was the problem of too many tablets, significant metabolic complications and increased cardiovascular risk. Over the years, advancement in understanding the mechanism by which HIV cause disease had led to newer drugs with less side effects, more potent, and finally the polypills with three drugs in one tablet/once a day or four drugs in one tablet/once a day. This advancement has brought significant changes with regards to acceptability of treatment and the level of compliance. Revisions were also made to previous recommendations in which testing included an evaluation of risk behaviours and need for consents. The newly revised guideline of United States Preventive Service Task Force [USPSTF] now advocates routine testing for all ages 18-65 years. All current treatment guidelines are now revised especially those by Department of Health and Human Services [USA],World Health Organisation [WHO],International AIDS Society ,all now recommends treatment for all infected with HIV virus irrespective of stage or duration. There is no more need to stage prior to commencement of treatment. It is hoped that the above two steps, screen all, treat all will help further in curtailing new infections as zero virus in the blood translates to zero new infections in the community. In March 2013, a case of possible cure was presented at the 2013 Conference on Retroviruses and Opportunistic infections in Atlanta by Dr Deborah Persaud, a virologist from Johns Hopkin hospital. She presented an infant from rural area of Mississippi who was delivered by a mother with HIV infection who never had any antenatal care. The child was started on multiple drug treatment 30 hours after birth considering her high risk with combination therapy. Blood tests on 3 occasions demonstrated HIV in the blood. He was on treatment for 12 months but was lost to follow up. During this time, the mother did not give any treatment. When the child was seen 12 months later, there were no more virus found. The implication of this finding is not yet conclusive but offers a hope of cure for infected new born infants. Prior to this accidental discovery, Timothy Ray Brown, a Berlin patient with leukemia had bone marrow transplant in 2007 from a donor with rare genetic mutation that can resist HIV infection while he continued anti-retroviral treatment. He was subsequently declared cured of HIV. Vaccine trial's have not recorded same level of success but the future is very bright. The need of HIV infected patients includes very good medical care, social support, family support and housing. The needs are mostly met with governmental financing, support from non profit organisations as well as privately funded foundations. Olayinka A. Adedayo MD,FACP The writer is a Diplomate of the American Board of Internal Medicine and a Member, New York Academy of Science.



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