Houseman tales: My HIV experience

While in school, I didn't understand the concept of hazard. Even when I started my internship, I didn't understand the reason why doctors took the hazard allowance so seriously not until a few months ago. As doctors, we are exposed to different hazards. We are exposed to infections, assaults, and even professional insults. A lot of doctors have come down with serious infections like hepatitis B and HIV. Some other doctors come down with depression due to stress and working in a toxic environment. Infectious diseases like HIV and hepatitis B can be transmitted without one knowing and as a result some of them come down with serious manifestations of these diseases that they did not bargain for. #### Just a short story... About six months ago, I was doing my neonatology posting in the university college hospital in Ibadan. By the way, neonatology is a branch of pediatrics that deals with babies aged from the first hour of life to their 28th day of life. These children can be very fragile and they tend to die if they don't receive adequate care.

On one faithful evening, some men rushed in with a set of twins who were so so little. They were pink and they were struggling to breathe. From the way they looked, I knew they were preterm babies.
I asked their age.
They were just 6 months old.
I asked the men who they were, one was the father while the other was a friend to the father.

I asked about the mother and they said she was on her way up. She couldn’t come up as fast as they could because she was really tired.

We had to resuscitate the babies immediately. We gave them oxygen to help with their respiration. They became a little stable and we told them that the babies have to be nursed in the incubator.

By this time, the mother had gotten upstairs. She was looking so tired and stressed.
We told them the cost of care and both the husband and the wife started shedding tears. At this point, I knew the problem was money.
I went on to ask how much they had and they told me they were with only five thousand Naira($10).

I didn’t know what to do. I saw the twins again and felt pity for them and decided to ask everybody to contribute so these twins could live.

While asking for contributions, I remember they were not eating and so I wanted to check their blood sugar.
I checked the first baby, and his blood sugar was fine. I then went on to check the other baby’s blood sugar and it was very okay.
Just as I was about to empty the sharps, I got pricked by the lancet.
I was calm and continued about my duties but somehow I was troubled.
I walked up to the mother of the babies and asked about her retroviral status(HIV status) and she said she was NEGATIVE.
I went back to continue my duty but I was still disturbed and called a friend to get me some HIV test strips.
I discovered she was trying to be shady and before I came back she was not where she was seated.
I tracked her down and found her sitting alone near the elevator.
When I found her, she was alone. I tested her and it turned out that she was positive. I asked her when she noticed she had HIV, she said about 7 months.

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I also asked if her husband knew her status and she said she didn’t want him to know. She begged me not to tell him.
I was angry as to why she didn’t want to inform her husband. Well, that was not my business and then I asked my final question and that was if she was taking her drugs properly. She claimed she was taken her drugs.
I ran to the emergency to see the staff clinic doctor so he could guide me on the steps to take so I don’t get infected. He started me on Tenofovir, Lamivudine, and Dolutegravir (These three drugs are the combination drugs for post-exposure prophylaxis)
He then instructed that I go see the HIV doctors the next day and there I was counseled and given more of the TLD drugs to take for 28 days. I was not, meant to miss a dose and I didn't.
The starting days were not easy but as time passed, I got through with the drugs.
I tested myself 5 months after, and I am negative. I intend to go and check in 3 months’ time again.
Sadly, the babies died shortly after due to a lack of funds to help with treatment.

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Moral of the story

• HIV is one of the most terrible diseases when left untreated. It can manifest in all the systems of the body.
• HIV can be passed from mother to child. This transmission is also known as vertical transmission. However, there are factors that can prevent this.
• Increase in CD4 count and a decrease in viral load are the main factors that help reduce transmission. CD4 cells are immune cells that help to fight the virus.
• Taking the drugs religiously help to reduce the viral load and this in turn help to reduce the risk of transmission.
• Also, it can be transferred horizontally through sexual intercourse, needle pricks, and contact with body fluids. This transmission is also dependent on the above-named factors.
• Adherence to routine drugs reduces the risk of transmission of both horizontal and vertical
• Needle prick injuries are very common and it is important that when you sustain a needle prick injury, you do a rapid test for HIV 1 and 2, Hepatitis B, and hepatitis C for yourself and the patient or the person.
• Post-exposure prophylaxis drugs are drugs that are taken when one has been exposed to a person with HIV in order to prevent the infection. It should be taken as soon as you get in contact with an infected person. Contact in this context means body fluids, sexual intercourse, needle pricks, etc.
• Post-exposure prophylaxis is very effective within the first hour to the 72nd hours. The earlier you start, the better the outcome. It has been reported that the efficacy of PEP is over 80% and it gets higher if you start earlier.
• You are expected to take the drug every day and never to skip anyone for 28 days.
• Using the drug alongside something you do every day like brushing increases adherence and compliance.
• Thes drugs have side effects and routine tests like liver function tests and some blood tests are usually done before the commencement of the drugs. Other side effects include weakness and malaise.
• For patients with HIV, who experience side effects from the drugs should preferably use them at night so the effects can wear off before their day starts.

This should be all for now.
Thank you for reading.