Dr Hilda Ganesen

Dr Ganesen has extensive experience in the management of HIV infection.  She published a journal article detailing the anti-retroviral treatment (ART) clinics which she initiated in the Department of Health in 2007. A copy of the article is available at the bottom of this page.  This publication was part of her Master's Degree in Family Medicine at the University of KwaZulu Natal

Dr Ganesen is an active member of the South African HIV Clinician's society.  She regularly attends meetings on advances in HIV treatment.

Dr Ganesen is listed as a Discovery Health HIV premier plus network doctor.  If you are a Discovery Health member, she will register you for chronic benefits for HIV and manage your treatment.  She manages HIV as a chronic disease with most other medical aids in SA.

 

HIV Diagnosis

If you were exposed to HIV (needle stick injury, exposed to blood, unprotected intercourse, rape) then you need to see a doctor asap for Post Exposure Prophylaxis (PEP).  This is treatment that we prescribe to prevent you from becoming HIV positive.  However, treatment needs to be initiated within 72 hours of exposure. 

 

There are various tests that can be done to determine if you have HIV following exposure.  The diagram below outlines the possible times when these tests may be done.

 

Rapid HIV antibody testing is done in the rooms. Pre and posttest counselling is provided.   Results are available within 15 minutes in the rooms. A rapid antibody test detects an infection that has been present for a while.  If a new infection was acquired in the past 3-4 weeks, this test negative. A blood test is required where blood is sent to the laboratory. 

 If a new infection is suspected, bloods will be sent for HIV ELISA or PCR tests to a local laboratory. You may be called in to receive the blood results.  If the result is positive, you will be counselled accordingly on the treatment options available. 

HIV Treatment

HIV treatment has changed drastically over the past few years.  We now have medication with minimal side effects.  If you initiate treatment early, take your treatment regularly and have the required routine tests and examinations done, you should live a long healthy life.  HIV is a chronic treatable disease.  Currently we do not have a cure for HIV but with correct medical management you can be expected to have a normal lifespan. We are no longer using a CD4 count as a point of reference for treatment.  Basically it means, if you are HIV positive, you need treatment irrespective of your CD4 count.  

Initiation of HIV treatment requires a few investigations. 

Screening tests: 

• Tuberculosis: A Sputum sample, chest xray and blood tests will be requested.
• Hepatitis B: A blood test is required.  If the test for hepatitis B is negative, you will be advised to take a vaccine to protect you against hepatitis B infection.
• Syphillis: A blood test is required.
• Cervical Cancer: A pap and additional blood test for HPV infection maybe considered.  If you can afford it, HPV testing is approximately R657.00
• Cryptococccal antigen testing if the CD4 is very low.

Investigations mandatory before anti-retroviral therapy: 

• CD4 Count,
• Viral Load, 
• Full blood count,
• Liver and kidney function tests

Once the basic investigations are done, treatment will be prescribed under close monitoring for side effects and opportunistic infections.

Cash patients initiating ART:

The cost of initiation treatment in 2020 is estimated at R790.00 for blood tests and R164.00 for a pap smear (females only).  All laboratory test must be paid for in cash which is sent to the laboratory with your blood samples.  No card payments will be accepted. A single consultation with Dr Ganesen is R580.00.  You will require two consultations with Dr Ganesen. During the pre-treatment consultation a history, examination and screening for opportunistic infections will be done.  Tests will be ordered.  You will be expected to return for discussion of the results and initiation of treatment.  Adherence to the ART and potential side effects will be discussed.  Thereafter you will be given a prescription for treatment to collect from your local pharmacy.  The prescription will allow you to collect medication from your pharmacy for 6 months.  Dr Ganesen will expect to see you every 6 months. A viral load must be done every 6 months.  Annually safety blood tests will be done i.e.: to monitor if the treatment is effective and for side effects of the medication.  Prescriptions will not be renewed without a consultation every 6 months.

As of 27 May 2020, the cost of the single first line combination antiretroviral tablet is less than R300. 

HIV medication is available at most government clinics.  If you cannot afford the treatment in the private sector, please access medication from the government clinics.  HIV is a treatable disease.  The current South African Department of Health Guidelines state that treatment should be available to all HIV positive patients.

 

 

HIV PrEP

At its 75th meeting on 27-28 November 2015, South Africa’s Medicines Control Council (MCC) approved the use of the fixed-dose combination of tenofovir disoproxyl fumarate and emtricitabine to include pre-exposure prophylaxis of HIV (also referred to as PrEP).

WHAT IS PrEP? It is a drug taken daily by people who are are high risk of acquiring the HIV infection.

Interesting facts about PrEP:
1. It is not a cure for HIV.
2. It does not prevent STD's
3. It does not prevent pregnancy
4. It is not a morning after pill ie: take it the day after risky behavior to prevent HIV infection
5. It must be taken daily for effective protection
6. It is not a vaccine against HIV
7. You can only take PrEP if you are HIV negative.
8. PrEP can only be prescribed by a medical doctor following the relevant tests.