Indians reach ‘AIDS condition’ later

[Guest guest]

Benaras varsity experts say Indians reach `AIDS condition' later

Study says Indians' CD4 lymphocyte count, on the basis of which AIDS

progression is measured, is lower than that of Caucasians

TOUFIQ RASHID. Posted online: Wednesday, July 27, 2005 at 0212 hours

IST

NEW DELHI, JULY 26: Researchers at the Benaras Hindu University have

found the CD4 lymphocyte count, on the basis of which AIDS

progression is measured, varies considerably in Caucasians and

Indians.

The study conducted by V Satya Suresh Attili, Shyam Sundar, V P

Singh and Madhukar Rai shows that the CD4 count is very low even in

a " normal " Indian compared to their Western counterparts. The study

was limited to north Indians.

The researchers say the use of US Centers for Disease Control (CDC)

categories of HIV disease severity to guide treatment decisions

could thus lead Indian patients to begin anti-HIV therapy

unnecessarily early.

They add that a reclassification is necessary since the CDC

classification for HIV/AIDS patients doesn't apply in India. " The

mean CD4 count among normal north Indians is significantly lower

than that in the western population and parallels that of the

Chinese... " the researchers say.

They said Caucasians reach what they termed the " AIDS condition " —

where the immune system becomes very weak — at a much higher count

of 200 cells/mm3 while Indians can go without treatment till 120

cells/ mm3 of blood.

The experts added that CDC guidelines require treatment to begin

when the patient falls into category C — a count below 200

cells/mm3 — while Indians have a competent immune system with no

treatment required till 120 cells/mm3.

CDC has three levels of HIV disease severity — CDC A, B and C — with

the latter being the most severe. However, the researchers have come

up with new categories that correlate better with the risk of HIV

disease progression in north Indians.

The findings are based on a cross sectional study involving 376 HIV-

positive patients from north India and 40 HIV-negative patients.

``The CD4 lymphocyte count had ethnic variability as observed in

many studies... As there is no such criterion currently available

for ethnic north Indian HIV patients, we undertook this study to

assess the applicability of the western case definition in north

Indian HIV patients,'' the researchers said.

Many studies conducted in the recent past support their findings on

the CD4 count of Indians.

A study by Dr Ramalingam and colleagues from the Christian Medical

College and Hospital in Vellore published in the National Medical

Journal presented nearly the same results after evaluating lympocyte

counts in 79 HIV-positive and 104 HIV-negative patients.

" It is well known that CD4 cell count can naturally vary between

different ethnic groups without influencing the risk of HIV disease

progression. An AIIMS paper published in the same journal showed the

variation last year,'' says Dr Pradeep Seth, former Head of the

Department at AIIMS.

Dr Seth who was principal investigator of the study said the reason

for the variation is not known. " We don't know why but this is a

fact. The reasons can be genes, environment or anything but it

doesn't affect the immune system competence,''he said.

Dr N K Mehra, HOD Immunogenetics and Transplant Immunology, also

agrees with the researchers' findings.

Dr S Y Quraishi, Special Secretary and Project Director NACO, said

the study spells good news for Indians if the findings are

confirmed. " It will take a lot of load off us as we are committed to

provide free treatment to people affected with AIDS in a phased

manner. This would mean that less numbers would be eligible for

treatment, " he said.

But he added that further investigations were necessary to establish

if the guidelines need to be changed for India.

http://www.indianexpress.com/full_story.php?content_id=75171