The number of HIV patients requiring third-line Anti-retroviral Therapy (ART) regimen, which has been just a trickle, is growing. Those requiring third-line ART regimen have literally nowhere to go, as there is no provision for them at government ART centres.
Those are tested HIV positive with a CD 4 blood count or less than 350 are put on the first-line ART regimen, according to the World Health Organisation (WHO) guidelines. Over a period of time, patients develop resistance to drugs in the regimen and are required to take drugs of the second-line ART regimen which are quite expensive. Similar thing can happen to those taking drugs of the second-line regimen. Only the first and second-line regimen drugs are distributed free of cost at ART centres. As a result, those who require drugs of the third-line regimen, which is expensive, have nowhere to go.
According to Dr. K. Satyanarayana Rao, ART Nodal Officer and head of the department of general medicine at Dr. N.T.R. Government General Hospital, the monthly cost of the first-line regimen ART drugs is between Rs. 2,000 and Rs. 2,200, while that of the second-line drugs is between Rs. 5,000 and Rs. 6,000. The cost of the third-line drugs is between Rs. 15,000 and Rs. 20,000.
While the first-line drugs prolong the life of a patient by 10 to 15 years, second-line drugs does it by 10 to 12 years. But, patients should not miss even a single dose. “If a patient misses taking the drug for two days, it leads to a 15 per cent increase in resistance, and if he / she skips taking medication for a month, it will lead to 50 per cent increase in resistance to medication,” Dr. Rao explained.
“Most private hospitals do not depend on CD4 count in the blood to decide if a patient required ART therapy. They subject patients to an HIV drug resistance test and directly go for the second-line ART regimen. After buying drugs for a couple of months, they approach a government hospital. Once the patient is put on the second-line regimen, there is no going back to the first-line,” he reminded.
How many are on ART?
As many as 40,000 HIV positive people have registered with the three ART centres in the State – NTR GGH, Old GGH and the Machilipatnam Government Hospital. The number of HIV patients registered at NTR GGH alone is 20,351. Around 800 of them are on the second-line ART regimen, and nearly 80 patients are drug resistant, and they require third-line regimen drugs. This can be established only by viral load test, which is available only in Secunderabad. Earlier, ART centres gave only the first-line regimen drugs. Incidentally, the Global Network of People Living with HIV/AIDS has been seeking free distribution of the second-line drugs. Though the number of people requiring third-line drugs is just a trickle now, it may go up in future. Currently, those requiring third-line drugs are being literally left to die.
What are the trends?
NTR GGH ART Counsellor Ch. Aruna Satish says most new cases that are reported at the centre are second-line ART regimen ones. Earlier, only the poor came for treatment to ART centres, but now even the middle class and upper middle class people, several of them requiring the second-line drug regimen, are approaching the centres, she adds.
Expansion of ART centre network
An office of the Andhra Pradesh State AIDS control Society (APSACS) office will come up in Vijayawada shortly, and the registration process required for it is over. The network of ART centres will be expanded from December 15, with new centres coming up in Guntur, Ongole, Eluru, Tirupati and Kurnool, in addition to the once currently functioning at Kakinada, Visakhapatnam and Vijayawada.
LINES OF TREATMENT
First-line ART (as per WHO guidelines)
*2 nucleoside reverse-transcriptase inhibitors (NRTIs) plus a non-nucleoside reverse-transcriptase inhibitor (NNRTI)
Second-line ART (WHO guidelines)
*2 nucleoside reverse-transcriptase inhibitors (NRTIs) plus a ritonavir-boosted protease inhibitor (PI)
