And the virus keeps being passed on… and on…

3 new cases were referred to me during my recent clinic duty – 1 divorced lady with 3 children, and the other 2 were a couple.

The first case referred was that of the divorced lady – small framed but she looked quite healthy really. I was quite surprised when upon browsing through her medical file, I noted that her CD4 was already below 50. And she had just been diagnosed only recently.

Rita, divorced just about 5 years ago, had not been in any sort of contact with her ex-husband since the divorce was finalised. Yes, she has 3 young children, aged 9 and below, but never once did the ex-husband even bother to find out how they are doing. Forget alimony.

So when Rita was tested positive, her ex-husband could not be contacted to check if he had been tested or if he was already seeking treatment elsewhere. Rita only mentioned that the last she heard, her ex had remarried.

Oh dear, that means very likely he had passed on the virus to somebody else as well… sigh…

Which comes to the question… aren’t all Muslims in Malaysia required to do the mandatory HIV test before they get married? Well, yes. So was he tested positive but the wife still agreed to proceed with the marriage? Or was it undetected during the test? Or did he find ways and means to either avoid the test (by marrying outside Malaysia) or to get a HIV –ve clearance without even doing the test? God knows…

Anyway, with a CD4 of less than 50, Rita will definitely have to start her ARV immediately. Being an educated person, it wasn’t too difficult explaining the implications to her and so I think she should be ready to adhere to her ARV treatment.

Next up was the couple. They came in with a young boy, about 1 year +. The nurse passed me 2 medical files – so I knew straightaway that both of them were HIV+.

Based on their story, they only found out that the wife was HIV+ only after she had to go through her c-sect when delivering the boy. All pregnancy cases would have been tested for HIV but apparently, for this lady, it was not detected during the initial test.

I was quite surprised when the husband said he just got tested and didn’t know his results yet. He wanted to know if he had been infected as well. Apparently this was the lady’s second marriage and she assumed she probably got infected by her late husband. She has 4 grown up children from her first marriage – one of them already working.

I told the guy that the fact that a file was already opened for him meant he was confirmed +ve as well. He seemed calm, either already expecting it, or he pretended he was unaware in the first place I don’t know.

After they left the room, I studied their files. The husband was tested immediately after the wife delivered their child, at a hospital in another state, and the result was +ve. They would have been told about the results then. So how come he was still asking about his test results? Did they not understand the first time around?

After reading their files further, I found out that they had defaulted follow-up appointments in that hospital after they moved to Perak. They never bothered to get referral letters and they never brought their child for follow-up after the child was diagnosed as negative. Or so they claimed. They sure seemed like one confused couple.

They finally went back to the hospital when they needed to seek treatment for their child who was down for some other ailment and that was when they got the referral letters to continue their follow up appointments in Ipoh.

It will be rather difficult to follow up on this case especially if they default any other appointments. With no phone numbers to contact, any follow ups on our part would have to be by way of house visits. Then again, without informing before hand, they may not be home when we visit. And based on what they said to me, they may be looking for another house soon.

I just hope they fully understood my explanation to them on the importance of adherence to all their treatments and appointments. They promised to inform me if they ever move to another house.

Guess I will just have to wait and see…