Elderly deaths in ‘HIV village’

The death toll is increasing in Battambang’s Roka commune, which has been plagued by a massive HIV outbreak, as health officials confirmed yesterday that two more HIV-positive villagers succumbed to illnesses despite undergoing antiretroviral treatment (ART).

The two elderly women, aged 74 and 75, died on Tuesday and Thursday respectively due to a possible culmination of underlying co-morbidities like typhoid and pneumonia, weakened immune systems and adverse reactions to ARTs, Dr Ly Penh Sun, director of the National Centre for HIV/AIDS, Dermatology and STD Control (NCHADS), said.

“With these cases, it’s always hard to say what the primary cause of death is … but the patients had other co-infections and their health was already very weak to begin with even before they started ARTs,” Penh Sun said.

Since the outbreak was first detected in December, the number of HIV-positive cases in the commune had, by Friday, risen to 236, with 157 patients on ARTs, he added.

The number of fatalities, however, seems to be disproportionately skewed towards elderly patients of the HIV-positive population.

In late January, a 73-year-old HIV-positive woman found to have tuberculosis died. A 6-month-old virus-stricken infant diagnosed with a severe respiratory infection was also among the fatalities.

“Older people are more prone to dying even when there’s no HIV. But with HIV, the risks definitely get higher,” said Dr ChelSarim from FHI360, one of the organisations providing four alternating medical teams that administer treatments at Roka’s health centre.

When treating elderly patients, health providers perform a comprehensive review of their current medical conditions and medications to tailor their ART regimen.

But if the treatment’s side effects – nausea, rashes, diarrhoea and nerve damage, among others – prove too much for their already-fragile states, patients are either taken off ARTs altogether or potentially prescribed with substitute drugs that vary from the standard adult treatment.

Some older HIV-positive patients also undergo combination therapies consisting of other medications to manage their discomfort and supplement them with nutrients like vitamins.

According to Sarim, 50 patients aged over 60 have been unable to start their treatment as doctors wait for their other co-infections like tuberculosis or hypertension to stabilise before initiating ARTs.

“There’s no A, B or C when providing treatment like this because everyone is different, but with the elderly, we have to be extra careful because they’re already weakened and we want to lengthen their lives,” he said.

Fatalities among patients with HIV, even those receiving ARTs, however, are not uncommon, said WHO’s HIV team leader Dr Masami Fujita.

“Unfortunately, this is normal,” Fujita said. “The vast majority of people get better under ARTs . . . but a small number of people die, especially those who already had health problems prior to treatment and those who start treatment later into their infection.”

Currently, a technical working group dealing with the HIV outbreak is discussing to improve ARTs and in-patient treatment for the infected group.

“The treatment is not perfect globally, but we are continually working to better them,” Fujita added.

ADDITIONAL REPORTING BY TAING VIDA