Sumit, who was diagnosed with HIV last month, suffered from cryptococcal meningitis after he started taking antiretroviral drugs.

Doctors at the antiretroviral treatment centre in Birgunj had recommended him antiretroviral medicine without examining the viral load status in his body. The 45-year-old from Amlekhgunj of Bara district had to be admitted to a hospital as a result.
Sumit has been undergoing treatment at Sukraraj Tropical and Infectious Disease Hospital in Teku, Kathmandu, for the last 19 days.
Dr Anup Baskota, an HIV clinician at the hospital, told the Post that the antiretroviral treatment centre in Birgunj prescribed medicines to Sumit without determining his CD4 level and the status of virus in his body.
As Sumit’s condition began to deteriorate, he was brought to Kathmandu by his wife.
“We stopped taking medicines and rushed to Kathmandu in an ambulance. My husband’s condition is still serious,” Sumit’s wife told the Post.
Like Sumit, who wished to be identified only by his first name, 24 other people infected with HIV are being treated at the Teku hospital for various complications caused by medicines given to them to increase their immunity power.
In Sumit’s case, Dr Baskota said, “the medicines inflamed cryptococcal meningitis, which had remained dormant in the patient.”
Doctors say cryptococcal meningitis is a serious infection of the brain and spinal column caused by cryptococcus fungus, and it could get severe if a person has a weak immune system.

When antiretroviral medicines are administered without determining the status of virus and CD4 count, there is a high risk of flaring up of previously acquired opportunistic infections among HIV patients, which could cause severe consequences—and sometimes death, say doctors.
Opportunistic infections include pneumonia, salmonella infection, tuberculosis, and others.
“Had the doctors known the viral load status, they would have suppressed the virus first before administering the antiretroviral medicines to Sumit,” Dr Baskota said. “But CD4 services are not available in most of the places.”
The National Public Health Laboratory under the Department of Health Services, which provides free CD4 count and viral load test services, said both services have been halted indefinitely.
The CD4 count is a test to measure the number of CD4 cells—a type of white blood cell, called T-cells—that move throughout the body to find and destroy bacteria, viruses, and other invading germs.
The CD4 count is a must to start antiretroviral therapy for people living with HIV and to confirm if the medicines are working properly. Viral load testing is a measurement of the amount of HIV in the blood.
“CD4 counting machines do not work and we do not have all the reagents to carry out viral load tests,” Dr Mukunda Sharma of the National Public Health Laboratory told the Post. She said that the National Centre for Aids and STD Control supplied some reagents but had not supplied consumables—testing apparatus such as blood collection and storage tubes— to perform the test.
Dilip Bhusal, a member of the National Association of People Living with HIV/AIDS in Nepal, said that dozens of people living with HIV, who reach the laboratory every day, are forced to return without having their CD4 count test.
He said that a lot of HIV infected people have been visiting Kathmandu, as the services are not available in many districts.
He said that the services have been affected as the concerned government agencies have failed to pay attention to the plight of HIV patients.