TOPIC criteria for ARV Therapy in resource poor settings

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Dear Forum, four messages- from Dr. Rakesh Bharti, Dr.Rajesh Gopal, Dr. R. H.

Uzgare and Dr Ajithkumar- in response to Meera's posting on ARV in

resource poor settings are combined.[Moderator]

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Anti Retroviral Therapy in resource poor settings Remember " TOPIC "

T for toxoplasmosis, O for oesophageal candidiasis, P for PCP, I for

invasive kaposi sarcoma and C for cryptococcal meningitis or CMV

retinitis

These are all the clinical criteria for starting HAART. Even the

presence of anyone of these requires ART.Besides this remeber minor

and nmajor criteria.presence of 2 minor and one major signals the

begining of ART. In children the rule is same but criteria is different

Dr. Rakesh Bharti

E-mail: rakeshbharti1@...

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In the absence of CD4/CD8 facilities you may rely on total lymphocyte

counts and the clinical criteria. You may get in touch with

Dr.Paranjpe at the National AIDS Research Institute who have carried

out excellent studies regarding the important issue.

Dr.Rajesh Gopal,MBBS(AIIMS)MD(PATHOLOGY)

E-mail: dr_rajeshg@...

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Firstly, CD4 test costs around Rs. 1000/-. You can definitely

negotiate with labs if you are going to do many tests. As per the

guidelines that are prevelant every seropositive person who becomes

symptomatic or suffers from OIs needs to be treated with ARVs, it is

clear that HAART should be offered to all such cases. It should be

under an expert's supervision.

If CD4 is also not affordable/available one can still offer HAART in

advanced cases as saving life is possible without CD4 or VL tests but

definitely not without ARVs. Initiating HAART is possible once the patient's

medical parameters are are known, because drug selection depends on those

parameters.

Dr. R. H. Uzgare, HIV/AIDS Physician, Mumbai

E-mail: druzgare@...

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There are various attempts all these years to find a clinical

criteria for AIDS. Personally in my clinic (300 patients over last

1and half year) we offer ART if patient gets any of the aids

defining disease (WHO stage 3 or 4) and they can afford to sustain

regular ART.I don't think we should worry too much about CD4 count as

it is expensive(1 cd4 = 1 month ART), many a time the results we get

are not very reliable due to various reasons and even the value of

CD4 cut offs are questioned.

WHO draft recommendations for resource poor settings is a welcome

step but in my opinion it needs to be reviewed several times to suit

resource poor situations. Personally I am not convinced regarding

the use of Absolute Lymphocyte Count.

Dr Ajithkumar.KSr Lecturer in Dermatology Medical College Chest

Hospital MG Kav ,Thrisur, Kerala,India. PH 0487-333322

E-mail: trc_ajisudha@...>