SEATTLE, Washington — In the United States, someone with a fever, cough and diarrhea would most likely be diagnosed with the common cold, stomach flu or food poisoning. In Africa, this could mean being diagnosed with AIDS. After receiving this diagnosis, those who can afford it begin taking a strong dose of a toxic drug, such as Nevirapine or AZT. On the off chance that the patient did have AIDS, his or her body would positively respond to the drug and would hopefully see improvements. However, the more common occurrence would be the opposite. A misdiagnosis of AIDS would result in a patient’s body pumped full of a lethal drug, further deteriorating the condition and potentially killing him or her.
The Bangui Definition
According to the World Health Organization (WHO), nearly 20 million people on the continent of Africa have supposedly died of AIDS since the disease became classified. Upon further investigation though, this number was found to be significantly inflated. WHO uses a different definition for AIDS in Africa compared to developed countries. This definition is known as the “Bangui Definition” and it relies solely on physical symptoms. The symptoms are broken into two categories, consisting of major and minor symptoms. Major symptoms consist of chronic diarrhea, chronic fever and weight loss. Minor symptoms include generalized itching and coughing. Doctors in Africa will diagnose a patient as having AIDS if they have two major symptoms and one minor symptom.
The problem with the Bangui Definition is that the symptoms it relies on are common. In fact, for the poor population of Africa, these symptoms are a daily reality. Those living in poverty in Africa suffer from malnutrition, a lack of safe drinking water, improper sanitation and no basic medical care. All of these can produce the same symptoms as above. Furthermore, malaria, tuberculosis and infectious diarrhea are some of the biggest killers for those living in African poverty. Unsurprisingly, these illnesses also share the symptoms listed in the Bangui Definition.
Potentially Lethal Drugs
The implications of such a weak diagnosis of AIDS can be fatal. AIDS includes a group of diseases that are considered severe. Consequently, treatment requires high doses of extremely powerful drugs. For the past two decades, UNAIDS has attempted to assist African poverty by providing the poor populations with access to these pharmaceuticals in hopes that the drugs would save the lives of people suffering from AIDS. However, when not distributed correctly, these drugs contribute to more deaths than lives saved.
Two of the most common drugs given to the African population are AZT and Nevirapine. These drugs are potentially carcinogenic, especially when administered at high doses. When given to patients without proper AIDS-related diseases, the consequences can be severe.
AZT and Nevirapine are meant to inhibit the HIV reverse transcriptase, which is an enzyme that is commonly found in most AIDS-related diseases. In patients who are misdiagnosed and given AZT or Nevirapine, HIV’s reverse transcriptase is not present, so the drug targets other enzymes such as DNA polymerase. By targeting enzymes that are necessary for an individual’s normal function, the drugs can have a fatal effect on the individual.
The Threat of Misdiagnosis
Simply put, western countries define AIDS differently than in Africa. This means the diagnosis of AIDS in Africa can include many other conditions not included in the western definition. Given this information, the treatment in the two countries should vary, but it does not. The high mortality rate in the poor population of Africa is not only due to AIDS-related diseases. Most of the deaths are due to illnesses resulting from an unclean environment, malnutrition and inadequate medical care. Merely pumping the poor population full of incorrect, yet lethal, drugs will not solve the problem. Instead, this will only increase deaths.
To combat the issue of toxic drugs in Africa, WHO suggests retesting all HIV-positive diagnoses for verification before starting treatment. Studies that have evaluated the costs and consequences of implementing this retesting have found that African countries will actually save $717 million by avoiding treatment costs for 180,000 misdiagnosed patients. Thus, retesting for verification is cheaper than providing treatment to false HIV-positive diagnosed patients.
The solution is to treat the problem. Organizations like UNAIDS and WHO need to lead the way in retesting HIV-positive diagnoses in Africa to ensure that only those with the disease are being treated accordingly. These toxic drugs are only exacerbating African poverty by making people who don’t need them worse. There is more to be done to treat African poverty. Governments need money and resources to improve infrastructure development such as proper sanitation, basic medical care, plentiful, nutritious food and safe water. Doing so has the potential to save thousands of lives.
– Shvetali Thatte