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HIV therapy tweak

New Delhi, Dec. 10: People infected with the human immunodeficiency virus (HIV) across India will receive free anti-HIV therapy even while their immune systems are still strong under new guidelines adopted by India’s national AIDS control programme.

The National AIDS Control Organisation (Naco) will provide anti-HIV therapy when the number of a class of white blood cells called CD4 drops to 500 cells per cubic mm or lower, senior Naco officials said. Current guidelines call for therapy when CD4 drop to 350 or below.

Naco already provides free anti-HIV therapy to about 7.1 lakh patients in India. The new guidelines, in line with recommendations from the World Health Organisation (WHO) earlier this year, will require the government to provide anti-HIV therapy to an additional 1 lakh patients. While not a cure, the anti-HIV therapy keeps HIV loads low and prevents the catastrophic collapse of the immune system as CD4 levels plummet.

“We’ve initiated the process for procuring more drugs — we’ll begin to implement the new policy in about six to eight months,” said Bharat Bhushan Rewari, a physician and national programme official with Naco.

The WHO had said earlier this year that its recommendation for anti-HIV therapy at CD4 levels of 500 is based on evidence that treating people with HIV early can keep them healthy and lower the amount of virus in their blood and reduce the risk of passing the virus.

Naco estimates that about 2.1 million people in India are infected with HIV, and about half of them require anti-HIV therapy. “But about 30 per cent of people living with HIV remain unaware of their infection. Patients need to know they’re infected to seek treatment,” Rewari said.

He added HIV-infected people who receive treatment have average survival periods of about 15 years, while those who do not get treatment will die from opportunistic infections within about two years after their CD4 levels drop below 200.

Senior Naco officials said the agency was working with institutions to drive an “employer-led-model” of advocacy and testing, which will get companies to encourage their workers to test themselves for HIV and seek the therapy.

Health activists have been urging the government to make available free third-line anti-HIV drugs required by patients for whom the first-line and second-line drugs don’t work. But a senior official pointed out that the third-line drugs cost about Rs 15,000 per person per month, in contrast to Rs 5,500 per person per year for first-line drugs, and Rs 15,000 per person per year for second-line drugs.