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Introduction

Human Immunodeficiency Virus (HIV)
affects approximately 71, 000 Cambodians (UN AIDS, 2016). The virus infects and
progressively destroys a certain class of human white blood cell called CD4+ lymphocytes.
These cells are part of the body’s defence system against foreign cells, infections and cancers
(Cachay, 2018). The failure of this defence system is the cause of much of the complications
of HIV, including death. To be diagnosed with Acquired Immunodeficiency
Syndrome (AIDS), a person with HIV must have contracted an “AIDS-defining condition” (examples
include certain fungal infections or types pneumonia) or have a “CD4+ count”
less than 200 cells/mm³ (regardless of whether the person has an
AIDS-defining condition) (AIDSinfo,
2018).

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With proper management HIV is a highly
treatable condition and patients should live full and healthy lives (Deeks,
Lewin & Havlir, 2013). Standard antiretroviral therapy (ART) consists of the combination of
antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the
progression of the disease, also preventing onward transmission (WHO, 2018). However, where
access to adequate treatment and support is poor, HIV is deadly, with approximately
1 million people still dying from HIV-AIDS in 2016 (UNAIDS, 2016).

 

This study discusses several specific protocols
and outcomes for HIV patients at the institution Home of Hope in Phnom Penh,
Cambodia. These protocols include those surrounding; diagnosis, treatment and
monitoring of their HIV, in comparison with World Health Organisation (WHO)
guidelines and outcomes including ongoing symptoms and psychosocial support for
patients.

 

The overall results of this study were
incredibly positive including the standards of HIV medical therapy, adherence
and psychosocial support. However, three key areas for further improvement have
been identified. These are a) tuberculosis exposure prophylaxis, b) education
surrounding HIV monitoring details c) physical examinations of HIV patients,
with suggestions for possible relevant projects detailed later.

 

Global and
Regional Context

Since the first HIV infections were
detected and diagnosed in 1991 and the first AIDS cases in 1993, Cambodia has seen
a rapid spread of HIV (WHO, 2001). The major route of HIV transmission in Cambodia
is through heterosexual contact, especially from brothels or entertainment
places predominantly utilised by males, with married clients acting as a bridge
between high risk groups to housewives and children (WHO, 2001). Despite outstanding
progress in Cambodia, regarding new HIV infections (less than 1,000 in 2016)
and AIDs related deaths (estimated 1,800 in 2016) with many public health
campaigns, there remains a gap for those receiving ART for HIV, with 20% of
those infected not receiving ART in 2016 (AIDSinfo, 2018). These patients are
therefore at high risk of AIDS-defining illnesses and death.

 

Tuberculosis infection remains a leading
cause of death among people living with HIV world-wide, accounting for approximately
40% of AIDS-related deaths (WHO, January, 2018). In 2015, there were an
estimated 10.4 million cases of tuberculosis globally, 1.2 million of which were
in those living with HIV (WHO, January, 2018). People living with HIV are 20 to
30 times more likely to develop active TB disease, with HIV and TB forming a lethal combination; in 2016, approximately
0.4 million people died of HIV-associated TB globally (WHO, January, 2018). With an estimated two thirds of Cambodian people carrying
the tuberculosis bacterium, there is inevitable co-infection with HIV (USAID,
2017). In 2016, 86% of new and relapsed tuberculosis cases in Cambodia occurred
in patients with a previously known HIV positive status (UNAIDS, 2016).  Statistics such
as this outline the importance of screening at the time of diagnosis of HIV for
illness such as tuberculosis or viral hepatitis.

 

Populations at risk of HIV
also experience higher rates of depression, anxiety, smoking, harmful alcohol
use and substance or alcohol dependence resulting from chronic stress, social isolation,
violence and disconnection from a range of health and support services (WHO, 2014).
In addition to poor quality of life, mental health disorders in people living
with HIV may interfere with treatment initiation and adherence and lead to poor
treatment outcomes (WHO, 2014). This is particularly challenging and relevant
in countries such as Cambodia with many citizens having low access to
healthcare and traumatic past experiences given its relatively recent history
as a country. 

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