Will I take ARVS all my life?

By Dr Vincent Karuhanga

I started HIV treatment in 2014 and whenever I test, I am told the virus is undetectable. However, the doctor still tells me to take drugs. Why? Musa

Dear Musa,
HIV Infects the cells with the so called CD4 (cluster of differentiation 4) receptors which are found on the surface of cells that help us fight infections called immune cells. These cells include T helper cells, monocytes, macrophages, and dendritic cells.
Dendritic cells of the type Langerhans cells are found in the skin (papillary dermis), around blood vessels, and the soft membrane (mucosa) of the mouth, foreskin, and vagina and are important in taking in the body HIV germs.
The immune cells are multiplying all the time to replace dead or injured ones or in case of infection they multiply to effectively fight the germs. Once our bodies are infected with an HIV germ, the germ multiplies rapidly using our own immune cell multiplication systems and enzymes.
The drugs used (ARVs) to fight the virus work through the immune cells multiplication systems to block the HIV virus and clear the body of the virus but the virus may remain in those immune cells that are not multiplying or in areas where the drug may not reach (sanctuary areas).
Upon stopping treatment, the virus will bounce back from the sanctuary areas, multiplying very fast with a likelihood of creating viruses that may be resistant to the drugs that were once very effective.
Cure of HIV then may come about with drugs that can access the sanctuary areas such as the lymph nodes and kill the germ from there but otherwise people living with HIV infection have to continue taking ARVS indefinitely.
Having no detectable virus in blood means one is using effective drugs and is less likely to spread HIV infection but not that he is cured of HIV infection. Even when there are no HIV germs in blood, HIV tests for HIV antibodies will still be positive once one is tested using our usual HIV testing methods in ordinary labaratories.
So, Ugandans should stop thinking that once one has no detectable HIV virus in blood he is cured and HIV tests will then be negative. There are no drugs yet that can cure HIV infection or make an infected person negative.
This is the reason the doctor is encouraging you to continue taking your medication.


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