Re: Guidelines for CD4 testing by private providers

[Guest guest]

Dear FORUM,

The patients on treatment before ART centers may have higher CD4's is first

thing, the other thing is waiting for CD4 of such patients may result in

treatment interuuptions.

Not only this the guidelines regarding CD4 are for asymtomatic patients and not

those who present with AIDS defining ailments.

Why ARV centers forget the other parameter of viral load-if mRNA is more than

100000, then whatever id CD4 we have to offer ARV. These lacunas should be

looked into fast.

One of my patients reffered to ARV center of PGIMER almost lost his life as his

CD4 under treatment was higher than cut off and was told that he does not

require ARV at all.

The other point I raised earlier remains " that involvement of PP's in whom

patients have faith should be involved at the earliest both for ARV as well as

ATT "

Dr.Rakesh Bharti,

Amritsar

e-mail: <rakesh.bharti1@...>

[Guest guest]

Dear Forum,

I also agreed with Dr.Rakesh,that using only CD4 as a sole criteria to initate

ARV, could be misleading,unreliable and risky for many people living with HIV.

I knew personally many people whose CD4 as high as 700 but having multiple

symptoms.

Why can't we start ARV when a person's present clinical symptoms of AIDS

defining illness, irrespective of CD4 count or in absence of viral load.

We(NACO)must refer and adopt WHO guidline for initiating ARV, in practice.

I also believe that if have to achieved Universal access by 2010, we have to

involve reputed Private practioners and primary health centers to provide ARV

and adherence counselling.

regards,

Loon Gangte

Delhi Network of Positive people

e-mail: loon_gangte@...

[Guest guest]

Dear Forum ,

I fully endrose the view point given by Dr Bharti regading the guide lines

issued to ART centers regarding the initiation of ARV therapy by these centers.

I have reffered some patients to these centers who were under my treatment since

long and they have achieved signifant higher cd4 counts who were denied given

ARV therapy.

Again, I want, there should be direct contacts between these centers and

few AIDS specialist like us who are having expierence of treating such cases

since > than 12-15 years, so that at least patient sholud not suffer.

DR RAVI SAINI

AIDS AWRENESS GROUP '

AMRITSAR

email: ravisaini@...

[Guest guest]

Dear Forum,

Very valid point is raised by Dr Bharti and others. We have to look for

initiation of ART in certain patients with CD4 even > 200 as per standard

guidelines of CDC and WHO.

Dr Diwakar Tejaswi

Medical Director

Regional AIDS Training Center and Network in India (RATNEI)

International Health Organization

e-mail: diwakartejawi@...

[Guest guest]

Dear FORUM,

Re: Dr. Ravi Saini's posting on the Guidelines for CD4 testing by private

providers

The methodology suggested by Dr. Ravi Saini might bring in the following points

for discussion.

1. Who all can be the " Recognised HIV specialists " and what should be the norm.

2. What if the mechanism is misused by People(who might not be HIV positive) and

this is highly possible given the price of the ART.

3. On what basis you expect the ART medical officers to start ART for a person

without knowing his/her status?. (Even Genaral Practitioners do not accept the

X-Ray taken in a lab which they do not have any working relationship. They make

the patient to take another X-Ray in their own prefered lab on the same day).

4. Accessing VCT is very vital as it might help taking the survilence data at a

district level.

5. Also I feel at VCTC the attendees can get all basic information about

HIV/AIDS and also condom demo which might not be feasible at private clinics.

I am for public - private partnership but at the same time there should be

uniform guidelines and standard operating procedures across the clinics

designated to provide ART.

I am witing these things only to think further on the point made by you and

arrive at a solution. My intention is not to argue. Hope you take it in good

sprits.

regards,

Swami.

e-mail: <swamiiyer@...>