RE: Revised guidelines for initiating ART - WHO (comparision of 2006 & 2009 guidelines)

[Guest guest]

Dear Editor,

At the latest lecture by Dr Micheal Saag , he suggests to start

ART immediately (as soon as discovered, a person is positive) since that helps

the arrest of spread of the virus when viral load is reduced.

Please confirm with a doctor.

Thank you,

Sincerely,

Priyadarshi Datta , PLWA.

e-mail: <pdatta@...>

[Guest guest]

Dear Priyadarshi Datta and others,

This is a response from a doctor.

I request you all to read e rapid advise from WHO and CDC guidelines from USA

fully . What WHO gave us is a rapid advise the full report is due in March.

Staring early--as early as detection-- may have some impact in reducing the

morbidity if you use the drug combinations with low toxicity--we are yet to know

the long term toxicity of many drugs.

Also we should balance it with long term sustainability in a public health

program.

The number of lives we can save by increasing the threshold from CD4 of 200 to

350 and even 500 may not be very big and we may have to start and maintain large

number of individuals on tretment and manage the side effects.

So if we are following the regimens with stavudine--WHO recommend

facing out of stavudine-- and even zidovudine based regimen it may cause more

side effects than the advantage.

Also we dont know the long term adherance level of individuals started early .

Do they have equal committement to the treatment adherence equal to those who

have been to advance disease?

Do they need different strategy for adherence management?

What is our policy on second and third line ? how much resources a country can

earmark for this in a resource( both human , money and intellect) restricted

society?

But in the case of an individual who would like to have best possible

treatment which he can finance himself and use the best available

combination and be committed to adherence and be ready to face the possible long

term unknown side effects of newer drugs , starting at higher CD4 may be an

option but evedence for even this is not great!

Regards

Dr Ajithkumar.K

Tichur

kerala

--

Dr Ajithkumar.K

Asst Professor In Dermatology and Venereology

Medical college Chest Hospital

MG Kav,Trichur, Kerala ,India

Ph 04872333322 (res)

9447226012

e-mail: <ajisudha@...>