The switch of ARV drugs and its consequnces

[Guest guest]

Dear ART Program Managers and other forum Members,

 

This is regarding change of drugs at the ART centers in many places across

India.

Many people who have been in Nevirapine regimens had been asked to switch to

Efavirenz regimen in the last two months at many ART centers in states like

Rajasthan, Uttar Pradesh, Madya Pradesh, Tamil Nadu, Maharstra, Manipur etc.

People have been taking the drugs properly are worried of this sudden change.

They have been adhering to their previous combination of drugs and they are

comfortable with the drugs they have been prescribed, their CD4 counts have

improved and have been leading a normal life. People are yet to get used to the

Efavirez combination and are facing the discomfort of having to get use to the

side effects of the drug itself.

But above all  We are worried about the HIV becoming resistant to Nevirapine.

Resistance to Nevirapine can be a concern for all women/ couple who are planning

to have children in their lives. Nevirapine is the only drug that is used PPTCT

program. That too when we know that one time Nevirapine during the delivery has

a high level of chance for causing resistance.

The concern is also that if there are a large number of people with Nervirapine

resistant virus - won't it affect the efficacy of the PPTCT program?

While discontinuing Nevirapine, people feel that their choice of drug or

option will be limited and their choice when they really require a drug change

will be compromised.

And if the Efavirenz does not do well they will progress to a situation where

they will need Second line therapy. This is already not something that is

available for all.

Secondly when side effects with Efavirenze experienced by people are with their

thoughts and mood (depression, bad dreams, anger etc) people identify it as

directly affecting the brain.

This makes them feel that it is a poorer option in comparison to Nevirapine

especially when it comes to their own experience of using Nevirapine all the

while long and having enjoyed good health.

This we understand is due to large stock of Nevirapine drugs that is going to

complete its expiry date in March 2011.

Is this is a strategy from national program to maximize the utilization of the

drugs before its expiry?.

Some places they have been told that Nevirapine is out of stock.

We also understand that both men and women who has a CD4 of 400 or more with use

of Nevirapine are the ones who are switched to the Efavirez combination.

People have not been informed as to why this switch and are not provided the

choice of going through with their previous regimen.

They have not been counseled too.

Though there have been friends who raised this in AIDS India Forum - National

program has not addressed this concern of people living with HIV.

The cost, stock and expiry of the drugs may be a factor for making this decision

on switching the drug at a national level, but doesn't the managers of the

nationwide ART program need to understand its larger impact on people, their

adherence to treatment, resistance etc before a decision such as this is taken.

If there was a larger consultation around switching in regimen at the national

level we would request you to kindly share the excerpts of such deliberations

and decisions along with their justifications.

 

Looking forward to your support

People living with HIV