Some of the current issues in the field of HIV treatment

[Guest guest]

Dear forum,

To day I read two important postings quoting two eminent personalities in in

Indian HIV scenario; Dr Kumaraswamy and Dr Mayer.

These highlights the issues which we in the field of treatment are facing.But

the problems are much worse in most of the places. Our problem is not the non

availability of Gancyclovir or the best possible infusion pumps (or not even

non availability of having ART). We face larger problem of non availability of

Co- trimaxazole and non availability of doctors who are trained in HIV medicine.

Availability of " Centers of excellence " in the big towns and availability of ARV

in selected centers is good but we doubt how effective are they in combating

general epidemic. There are centers which only breed resistance and export by

starting all kind of regimens with out even considering the feasibility of

continuing medications.

Now eight states have started free ART with minimal training of HCWs (5 days

formal training for doctors who are seeing HIV for the first time makes them

capable of treating HIV and providing ARV!).

It is unlikely that these centered will see many side effects of ARV in the

initial period as these doctors are not trained for that. One doctor said

" patients will eventually teach us side effects " .

In my limited experience we are seeing many cases of immune reconstitution,

lactic acidosis and other side effects of ARV in patties started on ARV and

unfortunately there very little mention about them in the training modules by

NACO/WHO. Interestingly WHO/NACO scaling up strategy opts a public health

approach but it is being implemented through tertiary level centers!

We are instructed to use WHO staging for selection of patients in tertiary

level centers!

This can lead to a situation of localized lymph node TB patients and patients

with prolonged fever and bedridden patients being started on ARV without getting

investigated and eventually end up with large abscess or die of Immune

reconstitution.

Interestingly this can happen in tertiary level centers now if doctors follow

guide lines. We also see patients who both economically socially and hysically

do better when they are off ARV.

My comments are not to undermine the efficiency or need of ART but to promote

implementation of proper ART program

Ajith

E-mail: <trc_ajisudha@...>