When gaining weight is a good thing

I first showed this picture about 11 months ago.
At the time, I was wondering why some people who are sick with HIV wait so long before seeking treatment, often dying before the anti-retrovirals can take effect. But this woman, named Nomanesi, had been very active in her own care and, on the day I took that previous picture, had just received her first ARVs.

I saw her in the clinic again today, a routine visit in which she came to get some vitamins we distribute to HIV-positive patients and a nutritional supplement. She had also just returned from the ARV clinic so I made her repeat last year’s picture.
I also checked her medical records. In the 11 months since she’s started ARVs, she’s gained 12-kilograms. That’s a substantial amount of weight and an undeniably good thing. She looks healthy, feels stronger, and generally has a better quality of life.

Also today this gentleman came into the clinic.
He tested positive for HIV about a year ago but hasn’t been in the clinic in more than six months. He’s long since run out of vitamins and the nutritional supplement. More importantly, he’s never had a CD4 count that would track the progression of the virus and determine when he can start ARV preparation. Today he was weak, gaunt, barely able to walk on his own, and had all the symptoms of tuberculosis. We drew blood for a CD4 count and gave him sputum pots to test for TB. I hope this time he doesn’t wait six months before returning to the clinic.