As the massive HIV outbreak in Battambang’s Roka commune continues to expand with new positive cases, many living with the infection are in rapid decline since the outbreak was first detected in early December, according to health experts.
“The situation is getting much worse from before,” NCHADS deputy director Dr Ly Penh Sun said. “There are some patients who have really weakened immune systems and are becoming much more susceptible to diseases.”
Due in part to the villagers’ deteriorating status and a high number of co-infections with other diseases, the WHO and NCHADS believe the outbreak attributed to injections from an unlicensed doctor began long before it was detected.
“Because there are varying degrees of immunity among the HIV-positive patients, the impression we get is that this infection has been spreading way before early December,” said the WHO’s HIV team leader Dr Masami Fujita.
The WHO is currently performing “more sophisticated examinations” to determine when the virus began its spread.
Over the past two weeks, two HIV-positive villagers from Roka commune – a baby girl and an elderly woman – both died in the hospital, according to their relatives and officials.
The 73-year-old woman was found to have a co-infection with tuberculosis, the leading cause of death worldwide for people living with HIV.
The 6-month-old infant was diagnosed with a severe respiratory infection that led to the collapse of her lungs, according to her mother, who is also HIV-positive.
“We started taking anti-retroviral treatments [ARTs] … but my daughter could not stand the treatment so she was kept in the provincial hospital for a week then transferred to Kantha Bopha Hopsital in Siem Reap … and after three days she passed away,” mother Chan Cheoub said.
“HIV-positive people have really weakened immune systems that are more sensitive to other diseases,” Fujita said.
Roka commune deputy chief Soeum Chhom estimated that nearly a third of those who have been diagnosed as HIV-positive are now in critical condition, a figure disputed by the government health authorities.
“These people have other physical ailments such as tuberculosis and lung, liver, and heart diseases,” said Chhom, who along with his wife also tested positive for HIV.
Despite a rising severity in the cases, the government is providing free ARTs only to those whose HIV has progressed to kill a large number of white CD4 lymphocyte blood cells. A healthy person has a range of 600 to 1,200 CD4 cells.
“Once they have a CD4 count of 350 or below then they become eligible for treatment,” said Penh Sun of NCHADS. “This is our national standard. If they have higher CD4 count they are still healthy and don’t need treatment,” said Penh Sun.
According to the WHO, however, the international standard for administering treatment is a 500 CD4 count to stop the virus from progressing to more lethal stages.
But the point may be moot, as many countries are doing away with CD4 counts altogether in favour of stopping the disease’s progression earlier.
As of Friday, 234 people have been declared HIV-positive in the commune, but only 179 people – 28 of them children – are receiving ARTs, NCHADS said. Around 40 per cent of the HIV-positive villagers, NCHADS added, are not currently eligible for treatment.
The national program has also stopped giving treatment to elderly patients who cannot bear the side effects.
“This is uncommon as normal protocol dictates that elderly people need extra attention during ARTs unless they have very severe complications,” Fujita said.
Perhaps even more urgent than medication, NGOs working in Roka say, is food and financial support for villagers.
“The nonhealth aspects of the disease, the economics of day-to-day needs, are not being addressed,” said Oum Sopheap, of the NGO KHANA, adding that more than half of those in the commune earned under a $1 a day before the outbreak.
“Whole families are sick and don’t have any ability to earn money now,” he said.