When one gets diagnosed with HIV, there are laboratory tests that need to be done first. The very basic are the CBC, Chest X-ray, some lipid profile tests and the CD4 count test. These tests will determine if one has current infections, two to know the level of immune system. These tests forms part of the baseline tests necessary for the prescription of antiretrovirals and prophylaxes against infections. These baseline tests vary from treatment hub to another, and depends on the medical history and assessment of the doctor. Though in other countries, the Viral Load is part of the baseline tests, in the Philippines it is not because it is costly and only a handful of hubs has the VL machine.
Also, since the ultimate goal is to start ARV asap then will VL test after a year. The result should be undetectable VL at 1 year to know if the prescribed ARV's are working or not. If during 6 months of initiation of ARV, the CD4 continues to drop or the opportunistic infections still come out, the hub doctor will prescribe the VL and possible genotyping to identify which specific ARV in the cocktail is not working.
I remember when I got diagnosed with HIV, seven years ago. My Cd4 count was 74 and my VL was 111,000 copies. I was Stage IV AIDS. Very end of the spectrum, I should say, and if I didn't get any treatment then, with my recurring pneumonia, PCP, that is, I would be dead by now. I took the VL because I wanted to know where I would start. I want to know how fast I can rebound. It was more than P10,000 then at The Medical City where I was confined. Too expensive but it also served as a baseline where I can start working on. After a year of religiously taking lamivudine, tenofovir and efavirenz (LTE), my cocktail up to now, my VL count became undetectable, around 32 copies. Till now I maintain that VL count.
Unfortunately, most hubs in the Philippines have no VL machine, thus clients up too now don't know their VL count. Though this is the goal, most doctors just rely on CD4 counts and the non-emergence of opportunistic infections. This is very unfortunate though as we are not educating everyone about the value of VL. One time during my hub visits, I was fortunate to get to conduct a brief support group talk to inspire their clients. I was shocked that they don't even know what VL is. Some hubs, even with suspected treatment failure, doctors just tell their clients to take the VL but not putting pressure on their clients that this is very necessary. This is happening now to one of the known advocates I know. Negligence both on the part of the client and the hub doctor, can be very scary.
I asked once my good doctor, Dr. Ditangco so to why do we keep on monitoring the VL. She said that HIV can still be resistant to the medicines that we are taking, even though we are taking them for a long time. This maybe a result of a missed dose during the first year as HIV a "memory" and look for weaknesses in our treatment process. Sometimes, but not being adherence for sometime can really break the chain and enable the HIV to fight against the very medicines to fight it. She said treatment failure can easily be detected by VL.
That is the reason why during the writeshop of the revision of the OHAT Guidelines of PhilHealth, I stressed the importance of having VL as part of the coverage of the OHAT Package (Out-patient HIV and AIDS Treatment Package). Dr. Anne Remonte said, what about those hubs that don't have VL and what would be the impact of that in the coverage. I said, that if they want to really care for their patients, hubs need to partner with hubs with VL machine and once they get the OHAT reimbursements, they need need to pay their partner hub. This is very easy, as long as the hubs think and care for their patients by utilising the OHAT package appropriately. Dr. Remonte of PhilHealth agreed to my recommendation.
Viral Load is very important. It is a responsibility for us, people living with HIV to ask every year for a prescription, and a responsibility of the hubs to cover it as part of the OHAT package. We all need to make this happen or else the money that PhilHealth is giving the hubs and being reimbursed by the hubs every quarter will just sit there. As art of the community of PLHIV, we need to empower regulate ourselves to regulate this, demand if possible every year so that the doctors know that we are part of our treatment and we are a part in of stopping the epidemic of HIV in the country by making ourselves untransmissible by having a undetectable VL (U=U).
Reminder, Project Red Ribbon is a partner of Philhealth. Hubs should be giving all your laboratory tests for free if you are a member of PhilHealth. Even baseline tests should be covered as soon as you file your Philhealth contribution on day 1 as hubs will reimburse PhilHealth after 3 months. If your hub make you pay for your baseline tests or even the succeeding tests, please write us at contact@projectredribbon.org so that we can forward your email to PhilHealth. We can make your letter confidential.
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