Whats ARVs are available in India? Need a review of NACO policy on ARVs

[Guest guest]

Dear Friends

Let me ask about what ARVS are available in India? besides

Zidovidine/Stavudine+ Lamividine + EVF/Niverapine.

Only ABC Abacavir and one pead formulation which is still not being bought by

NACO and no ritnovir boosted regimes or second line drugs where some require

cold chain ( which are available in Africa)

and with the Govt treating only about 1,2000 people (May be a couple of

thousands more) Most people are still on private treatment at the cost of Rs

1,000/approx per month.

That also in conflict zones where ATT gets air lifted ( rightly so) but the ART

gets left behind in Manipur. I give a list of the ART available all over and

also the nos of pills required per day ( not the costs though nor their

availability)

It is wise, though, to start on first line drugs which NACO is doing and

somebody must be also lobbying for some more second line and better ARTs to be

made available in India(Am not talking about only the Govt. Perhaps, clinton

foundation?)

And, what about promoting one good example of integrating the Vertical DOTS TB

with the HAART (Even a pilot project will do)

What about Continuum of care? where in India 64% PLWHA get TB around a CD4 count

of 200-250. Side effects of ATT and HAART etc.

ABC: Abacavir (Ziagen)

APV: Amprenavir (Agenerase)

ATV: Atazanavir (Reyataz)

AZT: Zidovudine (Retrovir)

ddI: Didanosine (Videx)

d4T: Stavudine (Zerit)

ddC: Zalcitabine (Hivid)

DLV: Delavirdine (Rescriptor)

EFV: Efavirenz (Sustiva)

FTC: Emtricitabine (Emtriva)

INV: Invirase (saquinavir, HGC)

IVIG: Intravenous immune globulin

LPV/r: Lopinavir/Ritonavir (Kaletra)

NFV: Nelfinavir (Viracept)

NNRTI: Non-nucleoside Rev Trans. Inhib.

NRTI: Nucleoside Rev. Trans. Inhib.

NVP: Nevirapine (Viramune)

PI: Protease Inhibitor

/r: Ritonavir <400 mg/d.

RBT: Rifabutin (Mycobutin)

ENF: Enfuvirtide (Fuzeon, T-20)

FTV: Fortovase (saquinavir, SGC)

FPV: Fosamprenavir (Lexiva)

HU: Hydroxyurea

IDV: Indinavir (Crixivan)

INH: Isoniazid

RTV: Ritonavir (Norvir)

SQV: Saquinavir (Invirase, Fortovase)

3TC: Lamivudine (Epivir)

TDF: Tenofovir (Viread)

TMP-SMX: Trimethoprim sulfamethoxazole

VZIG: Varicella zoster immune globulin

Regimens # of pills per day

Preferred Regimens NNRTI-Based

efavirenz + (lamivudine or emtricitabine) + (zidovudine or tenofovir DF) –

except for pregnant women or women with pregnancy potential

No of pills per day----2-3

Preferred Regimens PI-Based

lopinavir/ritonavir + (lamivudine or emtricitabine) + zidovudine no of pills

per day-8-9

Alternative Regimens NNRTI-Based

• efavirenz + (lamivudine or emtricitabine) + (didanosine, stavudine, or

abacavir)

No of pills 3-4 per day. - except for pregnant women or women with pregnancy

potential

• nevirapine + (lamivudine or emtracitabine) +(zidovudine, stavudine*, tenofovir

or didanosine) -except with baseline CD4 count >250 cells/mm3 in women or >400

cells/mm3 in men

No of pills per day 5

Alternative Regimens PI-Based

• atazanavir + (lamivudine or emtricitabine) + (zidovudine, didanosine,

abacavir, or stavudine*) or (tenofovir + ritonavir) no of pills 4-6 per day

• fosamprenavir+ (lamivudine or emtricitabine) + (zidovudine, stavudine*,

tenofovir, didanosine, or abacavir)

no of pills 5-8 per day

• fosamprenavir/ritonavir† + (lamivudine or emtricitabine) + (zidovudine,

stavudine*, tenofovir, didanosine, or abacavir)

no of pills 5-8 per day

• indinavir + ritonavir† + (lamivudine or emtricitabine) + (zidovudine,

stavudine*, tenofovir, didanosine, or abacavir)

no of pills 7-12 per day

• nelfinavir + (lamivudine or emtricitabine) + (zidovudine, stavudine*,

tenofovir, didanosine, or abacavir)

no of pills 5-8 per day

• saquinavir (sgc or hcg)† + ritonavir + (lamivudine or emtricitabine)

+(zidovudine, stavudine*, tenofovir, didanosine, or abacavir)

no of pills 13-16 per day

• lopinavir/ritonavir + (lamivudine or emtricitabine) + (stavudine*, tenofovir,

didanosine, or abacavir)

no of pills 7-10 per day

Triple NRTI Regimen – As Alternative to PI- or NNRTI-based regimens

• abacavir + lamivudine + (zidovudine or stavudine*)

2 pills/day

* Stavudine is associated with higher rates of lipoatrophy and mitochondrial

toxicity than other NRTIs.

† Low-dose (100-400 mg) ritonavir

somebody must please look into this at the policy level

Lt Col AS Gurung

Army Medical Corps (Retd.)

E-mail: <anupsinghgurung@...>