The 2nd line of management on ARV Drugs by physicians in private sctors

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Dear Moderator,

NACO should understand that there are some competant HIV physicians

are there in private sctors also. There are many patients taking

treatment from these private sectors who also updating their

knowledge by attending Confernces and thru journals.

We had come across so many occassions of patients who need 2ND LINE OF THERAPY.I

want to bring forth a recent incidence.

Knowing thru the drug marketting companies, an enthusiastic private practioner

fom a rural area,started a HIV positive lady on staudine, lamivudine,

nevirapine on one OD instead of one bid (twice daily).

The patient continue this drug for the past 3 and half years. Now her CD4 count

is just 60 only. This patient was not able to afford for resisstance test or

viral load assessment.

As we have no other options we have referred to Govt ART center where they plan

to put her on the same drugs in the correct dosage.

They are also have no options to refer this patient directly to 2nd line of

management to higher centers where they had been turned down.

AS THERE IS LOT POSSIBILITIES FOR THIS INDIVIDUAL WOULD ACQIURE DRUG RESISTANCE

to the common NRTIs AND NNRTIs thru TAMs AND M184v AND k103N, these drugs would

be useless and she will be an ideal patient for 2nd line of management with PI

containig regimen.

In this cotext, reference from privte HIV physician's recommedations also to be

honoured by these centers like Tambaram center, Chennai and JJ hospitals,

Mumbai.

We do come across patients who is having HIV2 infections also in our practice

where NNRTIs has no role also were given with same type of regimen which

contains NNRTIs by Govt ART cemters.

So the guidlines must be framed(revised) in such a way all these 2nd line

centers could be used by the Govt ART cnters directly and also for cases refered

by private HIV physicians if it realy proves to be worthy.

Dr S.Murgan

e-mail: <muruganyes@...>