In sub-Saharan Africa, physicians have few options but to treat HIV-related seizures with drugs that can interfere with antiretroviral therapies.

Often times, doctors are left at a crossroads when treating patients who've had seizures, then later discovering they’re also HIV-positive. In sub-Saharan Africa, it’s become a consistent problem.

People with stage 3 HIV have an 11 percent chance of having a seizure at some point if left undiagnosed or untreated. According to a study published in Neurology, physicians in sub-Sarahan Africa end up getting left with a life or death choice: Should we treat the seizure or should we treat the HIV?

Because getting treated for HIV in parts of Africa is much harder, countless of people are left untreated and find out their status while getting treated for something else, like seizures.

According to Epilepsy Society, ten million people on the continent of Africa are affected by epilepsy, and 80 percent of those are not being treated with new anti-seizure drugs. To make things worse, in some countries “there is one neurologist for every 5 to 10 million people” and “only five or six centers throughout the continent with up-to-date MRI scanners,” said Professor Ley Sander, Epilepsy Society’s medical director.

In the case of seizure patients with HIV, the study shows while a doctor’s first inkling is to have them start on combined antiretroviral therapy immediately, there is also pressure to treat the seizures. But because many of these regions don’t have modern anti-seizure medications, they have to rely on enzyme-inducing anti-epileptic drugs (which end up interfering with ART) — the study showed one-third of people who took AEDs along with ART were dead within a year.

So what is the solution? Researchers say it is not to be to take away AEDs from patients, but to rather get patients on ART much sooner.