No AID for these HIV patients
- An Acquired Immune Deficiency Syndrome (AIDS) patient (R) talks with a doctor and counselor. - A file photo.
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Over a period of time, patients develop resistance to drugs in the regimen and are required to take drugs of the second-line ART regimen which are quite expensive.
The number of HIV patients requiring third-line
Anti-retroviral Therapy (ART) regimen, which has been just a trickle, is
growing. Those requiring third-line ART regimen have literally nowhere
to go, as there is no provision for them at government ART centres.
Those
are tested HIV positive with a CD 4 blood count or less than 350 are
put on the first-line ART regimen, according to the World Health
Organisation (WHO) guidelines. Over a period of time, patients develop
resistance to drugs in the regimen and are required to take drugs of the
second-line ART regimen which are quite expensive. Similar thing can
happen to those taking drugs of the second-line regimen. Only the first
and second-line regimen drugs are distributed free of cost at ART
centres. As a result, those who require drugs of the third-line regimen,
which is expensive, have nowhere to go.
According
to Dr. K. Satyanarayana Rao, ART Nodal Officer and head of the
department of general medicine at Dr. N.T.R. Government General
Hospital, the monthly cost of the first-line regimen ART drugs is
between Rs. 2,000 and Rs. 2,200, while that of the second-line drugs is
between Rs. 5,000 and Rs. 6,000. The cost of the third-line drugs is
between Rs. 15,000 and Rs. 20,000.
While the
first-line drugs prolong the life of a patient by 10 to 15 years,
second-line drugs does it by 10 to 12 years. But, patients should not
miss even a single dose. “If a patient misses taking the drug for two
days, it leads to a 15 per cent increase in resistance, and if he / she
skips taking medication for a month, it will lead to 50 per cent
increase in resistance to medication,” Dr. Rao explained.
“Most
private hospitals do not depend on CD4 count in the blood to decide if a
patient required ART therapy. They subject patients to an HIV drug
resistance test and directly go for the second-line ART regimen. After
buying drugs for a couple of months, they approach a government
hospital. Once the patient is put on the second-line regimen, there is
no going back to the first-line,” he reminded.
How many are on ART?
As
many as 40,000 HIV positive people have registered with the three ART
centres in the State – NTR GGH, Old GGH and the Machilipatnam Government
Hospital. The number of HIV patients registered at NTR GGH alone is
20,351. Around 800 of them are on the second-line ART regimen, and
nearly 80 patients are drug resistant, and they require third-line
regimen drugs. This can be established only by viral load test, which is
available only in Secunderabad. Earlier, ART centres gave only the
first-line regimen drugs. Incidentally, the Global Network of People
Living with HIV/AIDS has been seeking free distribution of the
second-line drugs. Though the number of people requiring third-line
drugs is just a trickle now, it may go up in future. Currently, those
requiring third-line drugs are being literally left to die.
What are the trends?
NTR
GGH ART Counsellor Ch. Aruna Satish says most new cases that are
reported at the centre are second-line ART regimen ones. Earlier, only
the poor came for treatment to ART centres, but now even the middle
class and upper middle class people, several of them requiring the
second-line drug regimen, are approaching the centres, she adds.
Expansion of ART centre network
An
office of the Andhra Pradesh State AIDS control Society (APSACS) office
will come up in Vijayawada shortly, and the registration process
required for it is over. The network of ART centres will be expanded
from December 15, with new centres coming up in Guntur, Ongole, Eluru,
Tirupati and Kurnool, in addition to the once currently functioning at
Kakinada, Visakhapatnam and Vijayawada.
LINES OF TREATMENT
First-line ART (as per WHO guidelines)
*2 nucleoside reverse-transcriptase inhibitors (NRTIs) plus a non-nucleoside reverse-transcriptase inhibitor (NNRTI)
Second-line ART (WHO guidelines)
*2 nucleoside reverse-transcriptase inhibitors (NRTIs) plus a ritonavir-boosted protease inhibitor (PI)
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