On World AIDS Day, Medical Fraternity Appreciates New WHO Recommendations on HIV Treatment

by Divvy Kant Upadhyay,Manipal
Daijiworld Media Network

Dec 1: On the occasion of the World Aids Day, the World health Organisation has issued new guidelines that seem to have gained immediate approval from the medical fraternity.
For the first time, WHO recommends that HIV-positive mothers or their infants take Anti-Retroviral Drugs (group of Anti-HIV medicines) while breastfeeding.

According to NFHS-3 (2007) data, Karnataka ranks third in states having highest number of people living with HIV. The first two are Manipur and Andhra Pradesh. While the national prevalance was 0.34 percent (2.31 million people), Karnataka's was double at 0.69 percent.
In Mangalore and Udupi regions of Karnataka, as per the National Family Health Survey (NFHS-3) Data of 2007, 1 out of 100 pregnant ladies who turned up for Ante-Natal Checkup at hospitals was found to be HIV positive (0.9% prevalance).In 2006, WHO recommended that anti-HIV medicines be provided to HIV-positive pregnant women in the third trimester (beginning at 28 weeks) to prevent mother-to-child transmission of HIV. The 2009 recommendations promote the use of anti-HIV medicines earlier in pregnancy, starting at 14 weeks and continuing through the end of the breastfeeding period.

Doctors across India have felt the need for this for a long time. Associate Professor in the Department of Community Medicine at Kasturba Medical College(KMC), Mangalore, Dr B Unnikrishnan feels this move was long due. He says that HIV is a major problem in the lower socio-economic strata where the mother’s breast milk is the best nutrition the new born babies can get. Previously, HIV positive mothers were told not to breast feed the baby so as to avoid transferring the deadly virus to the babies. Parents who could afford were recommended Infant baby food formulas but the mothers who could not afford it were simply told to breast feed for the first six months and then start feeding the baby with mashed semi solid foods like bananas, cows milk, etc. Professor of Medicine at KMC Mangalore, Dr Mohd Ismail says the doctors and public health workers in India always knew the benefits of mother’s milk outweigh the risk of HIV infection from mother to child. Guidelines in this regard are a good step he says.

WHO now recommends earlier initiation of antiretroviral therapy (ART) for adults and adolescents, the delivery of more patient-friendly antiretroviral drugs (ARVs), and prolonged use of ARVs to reduce the risk of mother-to-child transmission of HIV.
Untill now doctors used to start Anti Retroviral therapy (anti- HIV medicines) when the count of particular cells called “CD-4” went below 200 in HIV positive patients. It is pertinent to know that HIV positive individuals do not die because of HIV itself. HIV attacks the immune system of the body – once the immunity is low – body is not able to defend itself against disease-causing organisms. At this stage various “opportunistic” infections set in that finally become the cause of death in HIV positive patients.

Now the WHO says it is best to treat HIV positive patients as soon as their CD 4 Count reaches 350 cells. Dr Ismail feels WHO may have been influenced by a meta-analysis study which was published by New England Journal of Medicine a couple of months ago which said that, earlier the anti-HIV medicines were started, the better for the patient. From his personal experiences, Dr Ismail goes a step further. After seeing certain HIV patients survive for more than 15 years and noticing that in the last two years the number of HIV cases in South Kanara region has dropped, Dr Ismail feels HIV should be treated as one would treat Diabetes or Hypertension – hinting that the medicines against HIV are working. Not only in treating the patients, but also stopping the spread to some extent. Dr Unnikrishnan feels the reduction in new HIV cases should also be contributed to major awareness drives among the public and medical fraternity.

The drug Stavudine which was used till about 6 to 8 months ago in India has now been recommended by WHO to be discontinued because of its irreversible side effects. Dr Ismail says that doctors and researchers in the West are positive about the benefits of an HIV vaccine which is undergoing trials. He is hopeful that the HIV Vaccine would play a much stronger role in controlling this stigmatous scourge.

The new WHO moves are bound to put a pressure on supply of drugs and logistic support as more people have to be treated now. With large amounts of funding, India should be able to adopt the latest guidelines that could help decline the spread of the disease. Stronger and enthusiastic approach for creating continuous awareness is still required. Declining figures in no way warrant complacency on our part.