Re: Post ARV deaths: Is a particular brand of drugs, the problem?

[Guest guest]

Dear FORUM,

Ref: Dr Daisy Dharmaraj's message on increased Post ARV deaths

With few years of experience in ART I think the problem you are facing is

inadequacy of the system to deal with ART roll out not because of the mere

absence of CD4.

Just rolling out ART is not going to solve the problem of HIV. For eg Around 7 %

of people on ARV can develop anemia due to ZDV it self.

If we don’t have a system which is capable of dealing with anemia how are we

going to address this? They can also develop problems a like lactic acidosis and

Immune reconstitution which can be lethal.

People on ARV can continue to develop OI s till they reach the CD4 well above

200 many a time much more aggressively.

That is why I am against the concept of ART clinic and ART roll out.

It should be at least HIV clinic and comprehensive care roll out.

Unless the whole system is ready to face the challenge of scaling up the health

care delivery system , I doubt how far our ART scale up is going to be

sustainable especially in areas where practically no health care delivery

system exists.

Dr Ajithkumar.K

Trichur, Kerala

e-mail: <trc_ajisudha@...>

[Guest guest]

Dear FORUM,

Dr.Daisy have raise few but important question on why people still die after ARV

treatment.

I would like to bring in another angle why people face a problem or death even

after on ARV treatment. That is Lack of Treatment literacy.

I mean to say many of the peole living with HIV doesn't have required/sufficient

knowledge about the treatment they are taking, but simply relying on the doctors

who doesn't always have the time to

explain. And also we still see some doctors giving wrong presciption eg. 2 drugs

instead of 3 or more.

Regarding perticular brands: I am on ARV (3TC+AZT+NVP) for the last 4 years, and

i have take all the brands that is available in India viz,

Cipla,Ranbaxy,Hetero,Aurobindo,Strides et al, whatever is the cheapest,for me

its not a problem.

I am on AZT, i closely monitor my Hb, and i'll take anything to improve Hb as i

am prone to anemia. I am on NVP so i watch my liver and do things to improve my

LFT.

We must scale up Treatment literacy in order to have sucessful HIV Treatment

programme.

Loon Gangte

Delhi Network of Positive People

e-mail: <dnpplus@...>

[Guest guest]

Yes, this is also a problem seen in other areas such as PNG.

Unfortunately I have not been able to get a good understanding of

exactly why this happens. Is it because treatment is started too late?

Is it aneamia compounded with using AZT instead of d4T? Or is it side

effects? Or non compliance for whatever reason? Poor medical

supervision? Bad prescription? Untreated co-infections? I wish I knew too.

--

M. Rock

3 Garnet St.

Coogee

NSW 2034, Australia

Ph. + 61- [0]2 -9665 - 9127

Mb. + 61 - [0]414 - 527- 111

e-mail: <johnrock@...>

[Guest guest]

DEAR GROUP,

This is in response to Dr Ajith's comment on ART roll out

It is true that right now Art clinics are doing a ration -shop like businees

delivering straight jacketed packages risking comprehensive HIV care.

It is unfortunate that the system could not build the capacity of equiping a

cadre of doctors in every state who can deliver comprehensive,specialised

quality care to HIV affected persons.

DR. UMESH SANKARAN

e-mail: <ummusen1957@...>

[Guest guest]

Dear Forum

We are conducting a short survey on post ARv deaths,as also pointed out by Dr.

Mira Shiva. As Loon says, treatment literacy is important. The majority of

people I am dealing with are poor.

Malnutrition is rampant. Some have tried out ARV earlier as prescribed by RMPs

or unaware doctors.

I will be happy to share the findings with anyone interested. Maybe some more of

us could investigate this aspect as well, and together we could learn what to

do.

CD4 testing machines are out of order in Guntur (for a long time) and Prakasam

districts. Does anyone know why these machines are not repaired on time? I guess

deaths of some hundreds of poor doenot matter, in India.

I sincerely hope 2007 would have more answers..

Happy New Year.

Daisy Dharmaraj

Dr. Daisy Dharmaraj M.D.

TEST Foundation

4/332 Pandaripuram

Chilakaluripet,Guntur District 522616

Andhra Pradesh, India

Tel +919444014170/9849081033

Fax 00914426250315

email testfoundation@...

testfoundation@...

website www.peopleshealthfoundation.org

[Guest guest]

Dear All,

That is an extremely valid point raised by Dr.Umesh. " ....need for equiping a

cadre of doctors in every state who can deliver comprehensive,specialised

quality care to HIV affected persons. "

In Gujarat with only two functional ART Centres and one more in the pipeline,

the ART care is additionally provided under public private partnerships with

Reliance Industries and the Surat Diamond Association.

We have chalked out capacity building of all the Physicians /doctors with

MD(Medicine) qualifications working in the medical colleges and bigger hospitals

in structured capacity building sessions at the NACO

recognized Training Institute at the ART Centre, Ahmedabad so as to enhance

their capacity to PROVIDE ART CARE WITH FULL KNOWLEDGE OF THE NUANCES AND

INTRICACIES OF THE REGIMENS AND THE FOLLOW UP CARE.

The CD4 testing is being outsourced and the state government has been requested

to supplement the support provided by the NACO to ensure ART

availability in a sustainable and responsible manner to all the neeedy PLHIV of

the state. A Composite proposal has been submitted and accepted in principle for

the same.

We hope to build a cadre of such physicians in all the

teaching(govt/private/Municipal)and the district hospitals to whom the ARV drugs

may be made available in a long term sustainable manner.

We are working on it and hope to get the desired support from all quartes for

this strongly felt need of the community.

Best wishes for a happy and prosperous new year!

Dr.Rajesh Gopal,

Gujarat SACS.

e-mal: <dr_rajeshg@...>