In about two years, Dr Surendra Patel who operates at MP Shah Hospital, has lost 10 of his patients who consulted him after being mismanaged by some people. Some of these patient had developed serious side effects resulting from either taking very toxic combinations or being on the drugs for too long.

Dr Ogengo Odhiambo, who also practices in Nairobi, says last year he too lost two of his patients who succumbed to the side-effects after taking the drugs not as prescribed.

An HIV expert who has been seeing Aids patients for over 20 years now, Patel says some of them were referred to him after some doctors had given them wrong combinations or failed to diagnose and stop the side-effect in their early stages.

“Although the benefits derived from ARVs still far outweigh the minor side-effects a patient experiences when taking the drugs, using wrong combinations may roll-back the gains we have made so far,” he says.

In one of the cases, a patient who had been referred to Patel died even before he started treating him.

Although the patient had experienced complications while taking the drugs, the doctor managing him was unable to diagnose the problem early enough to save the patient's internal organs.

By the time the family conducted Patel, the patient was experiencing deep and rapid breathing and abdominal pains. He died within twelve hours, even before the laboratory tests were complete.

But when the results were released posthumously, they indicated that the patient had suffered lactic acidiosis that was nine times higher the recommended levels. This was enough to destroy the patient's kidney and liver.

Other doctors too tell similar stories of witnessing patients lose lives as they fail to triumph over life-threatening ARV side-effects occasioned by using the drugs for too long, taking the wrong dosage, or combinations that are no longer in use.

In other instances, these side-effects become deadly if those dispensing the drugs lack the skills to diagnose them in time.

Although this is the reality, some of the doctors do not want to speak openly about it for fear of creating panic among people using the drugs, or those preparing to start taking them.

One of the reasons for their stand is that ARVs are able to salvage someone from a point of death to that of productiveness.

While at the same time these life-threatening side-effects affects some people and not others. They however become deadly if those affected are not put off the drugs immediately.

Evidence shows that taking ARV combinations that are no longer in use or very toxic ones may result in what is known as lactic acidiosis, which is more common in HIV positive pregnant and obese women.

Lactic acidosis is a condition caused by the buildup of lactic acid in the body when the liver or kidney are unable to shed off the excess acid.

The resultant effect is damage of these and other internal organs if the condition is left unchecked. The signs of severe lactic acidosis are deep and rapid breathing, vomiting, and abdominal pain.

Studies have attributed the condition to high mortality rates not only in ARV drug users, but also in other cases.

In addition to liver and kidney failures, an impaired pancreas is another deadly side-effect when one takes wrong or very toxic combinations, or is on the drugs for a very long time.

Dr Omu Anzala, a virologists and program manager of the Kenya Aids Vaccine Initiative, says the drugs by their nature of design, may inhibit a normal process of how certain enzymes function.

In the case of diabetes – a condition where the blood sugar is higher than normal-, when the drugs interfere with the pancreas, they may hinder insulin synthesis, which takes place in this organ.

Hence, low levels of insulin, which is responsible for controlling the high sugar levels in the body, results in diabetic or worsening of the condition.

High levels of blood sugar that are present in the body for many years, lead to the damage of the small blood vessels, increasing the risk of a person developing what is called late-stage diabetes complications.

These include: kidney diseases, heart attack, stroke, eye disease, nerves disease or hypertensions.

Similar effects of the ARVs on other enzymes especially those in-charge of breaking down fats in the body may hinder the proper functioning of the heart as the fats accumulate and interfere with tissues around it. If not controlled, a person may suffer a massive heart attack.

The issue of life-threatening side-effects occasioned by ARVs is one of those lined up for discussions at the upcoming International Conference on Aids and STDs in Africa to held in Abuja, Nigeria early next month.

Doctors want to understand well these complications as their countries increase, exponentially, the number of people using the drugs.

In Kenya, there are fears that if the way ARVs are dispensed is not well managed, with those using the drugs put under strict monitoring and management programmes, these side-effects are going to be more common, especially as the government moves ahead with its ARV roll-out programme.

Whereas Dr Munene Irimu, Head of Respiratory and Infectious Diseases department at Kenyatta National Hospital says all is still well at the institution, with very few adverse effects being reported, he wants the dispensation of ARVs to be controlled.

He says the government should restrict the number of people who can procure and sell the drugs to a few pharmaceutical outlets and hospitals.

The scenario now is everyone can buy and sell the drugs, with some people dispensing them even on the back-streets.

It estimated that 200,000 people, whose immune system is severely compromised, urgently need ARVs. So far over 40,000 people are using the drugs.

The government intents to put over 90,000 on treatment before the end of this year in line with the World Health Organizations 3 by 5 initiative.

According to the initiative, three million people globally should be on ARVs by the end of this year.

In the case of Kenya, medics say the only problem is, it is not clear what elaborate mechanisms the government has put in place to monitor people using the drugs under the roll-out programme.

Certain machines to test how one is responding to the drugs or their side-effects on organs such as the kidney and liver, are not readily available in many poor-settings.

Sometimes the costs of these tests are five times higher than the price of ARVs, making it difficult for poor patients to afford.

Majority of these patients are also unable to access HIV experts, who are either based in major towns or charge high consultancy fee, making monitoring a tall order.

Yet, according to HIV experts, some patients are dying from some of these side-effects because they are not monitored well, and end up consulting experts when their vital organs have already been destroyed.

For proper monitoring, a doctor or nurse is supposed to be knowledgeable about the side-effects, especially the life-threatening ones, so as to intervene at the earliest moment possible to reverse them.

At the moment, most of the nurses are taken through short-courses on ARV treatment before they can start dispensing the drugs to those who need them.

However, such training, HIV experts argue, may not help them determine some of the signs of complicated side-effects for purposes of referring them to an expert.

But Dr Munene, who is one of the doctors training these nurses, disagrees. He says they are offering refresher courses to update them on new development in the treatment of the disease.

ARV treatment and side-effects is also now part of curricular of some under-graduate and post-graduate courses.

Still, a number of doctors complain that the nurses are not being grounded well in drug combinations and how to tell, at the earliest opportunity possible, a deadly side-effects.