Re: The switch of ARV drugs and its consequnces

[Guest guest]

Dear all,

Re: /message/12534

We are also facing a lot of problems with this change. But every doctor I speak

to tells me it is a change for the better. I have a few questions for the

powerful decision makers.

1. Why were the PLHA on the previous regime not counseled / informed about the

side effects of this drug or the fact that it was a better drug?

2. None of the people who have come to meet me were even informed of the change.

I work with not literate persons who assumed the drug was the same in a

different box.

3. A lot of them who are taking Efavirenz now are unable to go to work.

Rural women who live as agricultural laborers and need to go to work

everyday, are deciding to stop using this drug mainly because no one thought

they need to be counseled about it.

Is it not interesting that the government claims that they spend so much money

on these programmes but are yet unable to run them efficiently?

Why is so difficult to treat people who are human beings with hearts and minds -

as human beings who have a right to get information on what is being

administered on them?

Meena Seshu.

SANGRAM+, VAMP, MUSKAN.

--

In solidarity,

meena saraswathi seshu

SANGRAM, Sangli.

e-mail: <sangram.vamp@...>

[Guest guest]

Dear Meena and other forum members,

I understand your concern about the future of Nevirapine becoming resistance.

Nothing to worry about the drug becoming resistance as both are NNRTI gruop of

drugs.

When we continue either of these drugs in the triple drug combination without

any interruption, we need not worry about the resistance.

At the same time, if one acquires resistance either of these drugs, will have

resistance to the other drug also. The same is called as cross resistance.

As far as one is not yet acquired any resistance to either of this drug, we need

not fear about switching over to another NNRTI.

Moreover Efavirenz is proved to be a better and efficient drug with lesser

complications. The initial problems of giddiness and all with Efavirenz will get

settled sooner or later with most of the indivduals.

Only thing is Efavirenz is not indicated in young ladies and girls who are

potentially likely to get conceived as it is producing unwanted changes in the

foetus. Otherwise Efavirenz is a good option.

 

Dr S.Murugan

Sr Consultant HIV Physician,

Tirunelveli- Tamilnadu

e-mail: <muruganyes@...>

[Guest guest]

Dear all

Re: /message/12534

Meena raises a very pertinant issue. One of the by products of this HIV

epidemic has been that " patients " and " people " have shown the experts and powers

to be that where there has been self organisation and for the want of a better

word " empowered " or collectivised groups the spread of the HIV infections has

been easier to prevent.

At least the language of community mobilisation and empowermnet has now entered

the prevention vocabulary.

However, from what has been said here it seem that the same ethos has yet to

be really embraced in the treatment sector.

People with knowledge and understanding and control over their illness/heath

condiiton are more likely to embrace and adhere to their treatment.

This is particularly important for health conditions that require lifelong

treatment, such as HIV, but also diabetes, high blood pressure.

Perhaps we should learn from prevention and give the community based

organisations and collectives greater control over the delivary of treatment for

HIV and other chronic health conditions as well.

Perhaps the time has come to test this new model of healthcare delivary and

see if it is better than hospital/clinic centred one that currently dominates in

most of the world.

Best wishes

am Shahmanesh

e-mail: <bamaryjoon@...>

[Guest guest]

Dear all,

 

Re: /message/12534

 

The fact that this is a better combination needs to be seen in a context. The

combinations used in the national program are almost equally effective on a long

term basis (except for those with stavudine in it).

 

So using efavirenz as a first choice drug would need more than one reason.

Inclusion of tenofovir or other non thiamidine analogues instead of zidovudine

is also being argued for by many (API guidelines). However for especially the

cost considerations the first choice ART regimen is fine. However the other

questions raised by you are even more pertinent:

 

Why was this stock out allowed to happen in the first place? May be no fault of

NACO but then still why? In such a situation NACO probably did the best thing-

substitute with efavirenz. But this has been done across board.

 

There are data which show that prior history of substitution is one of the

predictors of early treatment failure. Even if it is not still the whole

situation was unexpectedly thrust upon the patients without information and

counseling.

 

As I realize many patients started taking efavirenz in the morning and certainly

would lead to major side effects making people difficult to work. This means the

patients were not insructed to take efavirenz in the night. Neither was the food

interaction explained.  

 

This crisis has informed us about a major lacuna in the system and should be

addressed as a priority.

 

Vinay Kulkarni

PRAYAS, Pune.

 

--

Vinay Kulkarni

PRAYAS

Amrita Clinic, Karve Road

Pune 411004 (India)

Tel: 91 20 25441230

Tel/Fax: 91 20 25420337

Cell: 91 9822300532

prayashealth@...

www.prayaspune.org

[Guest guest]

Dear Forum members,

Re: /message/12534  

I have been following up postings on forum on substitution of Nevirapine based

regimen to Efavirenz and understand the  apprehensions  of the forum members

regarding this switch.

The decision to substitute Nevirapine based regimen with Efavirenz was taken as

part of inventory management and with the concurrence of chairperson

of Technical resource group on ART.

Efavirenz and Nevirapine are drugs from the same group (NNRTI) and switching

between them will not lead to any cross resistance as per available scientific

evidence world over.

This substitution has been done over years inside the program and world over

especially when the patients are on rifampicin based ATT regimen. It is also

known that few patients are likely to develop Efavirenz based side effects

(which is true regarding any drug), which becomes even more uncommon when

patient has already been on Nevirapine.

Usually these are transient and disappear in 1-2 weeks time. All the

ART Medical officers and counselors were instructed regarding the need for

counseling on these issues before change.

We are again issuing further instruction in this regard to all ART centers to

explain these possible side effects to patient before switching and advise them

to take Efavirenz at bed time.

If they continue to have problem with Efavirenz, they will be provided with

Nevirapine based regimen.

I would like to reassure the forum that if properly followed this change will

not lead to drug resistance to Nevirapine.

 

Dr B B Rewari 

e-mail: <drbbrewari@...>

[Guest guest]

Dear Dr. Rewari & Forum,

Re: /message/12545

The main issue here is " The decision to substitute Nevirapine based regimen with

Efavirenz was taken as part of inventory management and with the concurrence of

chairperson of Technical resource group on ART. "

We all know NVP & EFV is same class.

But i am sad to learnt that it seems now our treatment regime is decided by the

un/availability of the stocks, rather then our treating Doctors prescription

based on our various blood test report/medical history.

And this is evident when last month one of our friends who has a history of

neuropathy -d4T side effect was offer again d4T when was found out to be anemic

due AZT. Same logic both d4T and AZT same class of NRTIs.

So, i request let our treatment regime be base on our body needs rather then the

inventory of stocks.

Loon

e-mail: <dnpplus@...>

[Guest guest]

Friends,

Re: /message/12534

I feel the basic question is " why did this situation occur? "

An inquiry is needed so as to prevent " out of stock " situation for any

drug/combination as, if not now then may be in some other situations

results may be grave.

Dr.Rakesh Bharti

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

 --

Rakesh Bharti

MD,AAHIVS,

BDC Research center,

27-D,Sant Avenue,The Mall,Amritsar.

Punjab,INDIA143001.

TEl-91-183-2277822;91-183-2278522

[Guest guest]

Dear all,

Re: /message/12534

Instead of covering up the issue, NACO can get in to understanding the flaws in

their inventory management system for the benefit of the People living with

HIV/AIDS.

Dr. S.Raman

e-mail: <tenthplanet@...>