HIV in inpatients at Kagondo

Before the advent of antiretroviral treatment (ART) most African hospitals were full of patients with HIV and AIDS who were just not getting better.
In my time at Kagondo we have generally only about 2-4 patients with known HIV status. However in the last week we have had five. Two are not that sick and will go home maybe to start ART later.
However one arrived in a very sick state. A 30 year old woman who registered last June then disappeared only to emerge in Nairobi with TB and very sick. She started treatment in early January but despite TB treatment and ART she became jaundiced, deteriorated and died last week. Another was diagnosed antenatally last September but as she was an orphan and had no surrounding family and would not tell her husband ( for fear of being divorced), she disappeared and had her baby at home. She was admitted 3 weeks later with puerperal sepsis and has not responded to conventional treatment. She is very sick and will probably die leaving an orphan. The third one is an 18 year old who was diagnosed early last year and started on treatment. She defaulted and was again started on treatment in Septmeber. She again defaulted and arrived here just skin and bones looking like a forty year old. She is so ill it is difficult to know where to start and if she can tolerate the powerful drugs for TB let alone HIV and will she persist with treatment and how much resistance has she got already and do we risk furher resistance by her defaulting again.
These three contrast with the amazing response of many with a lady with a big cheerful smile coming in to the clinic on Friday with a weight of 60 kg , up from 45 kg just two and half months ago and full of energy and a great appetite.