HIV-positive patients in sub-Saharan Africa lack modern medications. Seizures are a common symptom seen which poses a great challenge for HIV caregivers.
Physicians are forced very often to choose between controlling seizures or treating the underlying HIV infection. Seizures occur if the disease is undiagnosed for too long.
The study published in the Journal Neurology, was undertaken for the purpose of identifying risk factors for seizures in HIV-positive patients and thereby providing physicians with a blueprint for care, it has instead highlighted the difficult decisions that providers and patients must confront.
In many parts of Africa there are still significant social and economic barriers that prevent people from being tested for HIV. Consequently, for some individuals the first time the patients are brought to the hospital is after a seizure.
Once this occurs, caregivers are forced into a no-win situation. Because the HIV infection is often advanced, the appropriate course of action is to aggressively start a treatment of combined antiretroviral therapy (cART).
However, at the same time there is a sense of pressure and urgency to treat the seizures as well, which represent a significant health risk if left unaddressed.
The dilemma exists due to limited treatment options. Most African regions with high rates of HIV infection continue to rely largely on older, enzyme-inducing antiepileptic drugs (AED) for seizure management.
Unlike newer anti-seizure treatments, these AEDs are known to interfere with cART, making the HIV treatment less effective.
Not only does this interaction place the patients at greater risk of death from the disease, also one third of the patients were dead within a year of their first visit to the hospital, but it could also gave rise to drug-resistant strains of HIV.
While the long term solution is to increase access to newer anti-seizure drugs, the authors believe that the priority should be to reconstitute the immune system by getting patients on cART as soon as possible.
The study was led by Gretchen Birbeck, M.D., M.P.H., the Edward A. and Alma Vollertson Rykenboer Professor in Neurology at University of Rochester Medical Center (URMC). Birbeck also serves as director of the Epilepsy Care Team at Chikankata Hospital in rural Zambia and is an honorary lecturer at the University of Zambia.
Authors acknowledged a treatment that omits AEDs that leaves makes patients vulnerable to reoccurrence of seizures, but believe that the HIV infection poses greater health risk in the long term.