The Hindu : National : India needs improved regimen of anti-retroviral drugs: expert

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Friday, Dec 07, 2007
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India needs improved regimen of anti-retroviral drugs: expert

M. Dinesh Varma

“This will help to reduce mother-to-child transmission of HIV”

CHENNAI: India needs to switch to an improved regimen of anti-retroviral drugs to cut down the risk of mother-to-child HIV transmission, says Philippe Van De Perre, an HIV expert of the University of Montpellier, France.

The preliminary findings of several ongoing global studies to determine the best possible matrix of drugs indicate that anti-retroviral drugs used in combo can lower the risk of parent-to-child transmission of the virus to between 1 and 2 per cent, Dr. Perre told The Hindu during a recent visit to Chennai.

“The major worry with a single dose regimen with just one drug like Nevirapine is the potential for the mother developing resistance when the drug is used at a later stage,” said Dr. Perre, whose specialised work includes parent-to-child transmission.

WHO-recommended regimen

The drug regimen recommended by the World Health Organisation involves AZT, Nevirapine and 3TC. It is effective in neutralising the virus across lifecycles, from 28 weeks into pregnancy to the post-partum phase.

“India should seriously consider adopting the WHO-recommended regimen to lower the incidence of parent-to-child HIV transmission,” said Sai Subhasree Raghavan, president of SAATHII (Solidarity and Action Against The HIV Infection in India).

(Currently, it is estimated that the parent-to-child transmission is 15-20 per cent if no intervention is provided.) Far from being improbable, adopting the WHO-advised regimen should be a viable proposition in India, as the country accounted for nearly half of the global anti-retroviral drug manufacture and exports anti-HIV medicines to over 100 countries, she said.

Non-compliance

According to Dr. Subhasree, any fear of non-compliance by those who get started on anti-retroviral drugs should not stand in the way of switching to a combo regimen as the public health system in India has been providing long-duration anti-retroviral therapy to over one lakh patients.

However, the big challenge is to make access to these drugs distributive and decentralised in a country where 50 per cent of the deliveries still take place in homes and 25 per cent of live births occur in private hospitals.

Proper sanitation

It was imperative that ART interventions be integrated with the existing, ongoing health programmes such as the National Rural Health Mission. This would require toning up of primary health centre infrastructure and the proper sensitisation and training of grassroots healthcare personnel, Dr. Subhasree said.

Pitfall

However, the pitfall to be avoided, according to Dr. Perre, was keeping apart prevention programmes and delivery of treatment. “The failure to link prevention with care and support has become the tragic flaw of many HIV/AIDS programmes across the world.”

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