All HIV patients to get second-line treatment free

NEW DELHI: All HIV patients put on first line antiretroviral therapy (ART) before 2004 but who became resistant to those drugs will now receive the life saving second line treatment free of cost from the National AIDS Control Organisation (NACO).
This is irrespective of whether the patients were receiving first line ART in a government centre or a private hospital. This major policy shift was finalised by NACO on Thursday night.
Till now, NACO only provided second line treatment to those HIV patients who were part of its ART centres and had become resistant to first line drugs.Those patients on first line treatment in private hospitals or clinics were not eligible.
Second line treatment is tremendously expensive and not affordable for the common man. Also, it was only available in NACO's ART centres. So, patients who did not get first line treatment in NACO's ART centres perished if they became resistant.
Solicitor general Gopal Subramaniam informed a Supreme Court Bench comprising Chief Justice S H Kapadia, Justices K S Radhakrishnan and Swatanter Kumar that the health ministry took this decision on Friday. He informed the SC that details of the decision would be intimated through an affidavit in two weeks.
So what happens to those who were put on first line ART post-2004 but have become resistant to first line drugs? Expert committees in the 10 centres of excellence presently in charge of giving second line treatment will take a call.
ART is the only known treatment that inhibits HIV. The drugs slow down the replication of HIV and immune deterioration is delayed leading to an improvement in the survival and quality of life.
While first line drugs cost NACO Rs 5,000 per patient per year, second line cost them Rs 35,000 per patient per year. Patients, however, get the treatment free of charge.
India is home to an estimated 2.3 million HIV patients of which 6 lakh would require to be on ART. At present, 3.55 lakh HIV patients are receiving first line treatment in 285 NACO ART centres.
Ten centres have rolled out second line ART to 1,701 HIV patients. Five more centres in Nagpur, Pune, Salem, Aurangabad and Surat have been trained to start second line ART while two centres in Vijayawada and Hubli are being prepared.
India rolled out second line ART for the first time on December 1, 2008 in Mumbai's J J Hospital and Chennai's Tambaram ART centre.
Resistance to first line treatment mainly happens because of poor adherence to the treatment regimen. If not put on second line immediately, most of these patients die within a few years.
A CD-4 count test is used to gauge immunity levels of an HIV-infected patient and to assess whether damage caused by the virus requires life-saving ART. The CD-4 count in healthy adults ranges from 500 to 1,500 cells per cubic millimetre of blood. In HIV infected people, it goes down by 60 cells per cubic millimetre of blood per year as HIV progresses. ART is administered when an HIV positive person registers a CD-4 count under 200.