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Abstract
MANAGING HIV/AIDS PATIENTS IN INDIA - CHALLENGING FOR HEALTHCARE PROVIDERS
J. Maniar, K. Shah, A. Maniar
Jaslok Hospital and Research Centre, and K.J. Somaiya Medical College and Research Centre, Bombay, India
Purpose of study : The HIV/AIDS epidemic is matured in India with estimation of 15 million people living with HIV( PLWA) by end of the year 2002, HIV-2 and dual infection besides HIV –1 exists. Majority of antiretroviral drugs are marketed in India with annual cost inclusive of monitoring tests US $ 480.00 - 960.00 (NNRTI), US $ 1920.00 (triple NRTI ) & US $ 1920.00 ( PI ). Various studies have proved that annual cost of treating opportunistic infections is significantly higher than that of ART. We aimed to study feasibility of expanding use of ART in current scenario.
Method : Number of individuals recruited between January 1998 – April 2002 : 3320. Baseline data recorded viz age, sex, presenting features, haemogram, ESR, Mantoux test, chest x-ray, sonography of abdomen / pelvis, liver function test, urine, and HBV & HCV serology. Specific tests to confirm opportunistic events. Management included: post test counseling, treatment of opportunistic events, focus on counseling to promote antiretroviral therapy, recruiting willing individuals for ART, baseline tests before starting ART and counseling during ART. Follow up included laboratory monitoring for efficacy, look for ART toxicities, and assessing adherence rate.
Result : Number of PLWA available for study : 3235, age range 18-25 years 12%, 25-40 years 83% > 50 years 5% . Gender ratio 3:1. HIV seroepidemiology HIV- 1 97%, HIV-2 1.5%, and dual 1.5%, asymptomatic individuals 8.5%, symptomatic individuals 91.5%. Presentation n = 3,015; PUO 94.5%, weight loss 91.5%, dermatological markers 82.5%, lymphadenopathy 78.5%, pigmentation 76.5%, anemia 74.5%, sore mouth 67.5%, weakness 66.3%, cough 63.5%, dysphagia 53.5%, CNS markers 49.5%, anorexia 45.5%, breathing trouble 42.5%, diarrhea 42.5%, GUD 21.5%, headache 6.5%, & joint pain 2.7% . Opportunistic events : tuberculosis 92.5% (pulmonary 56.5%, extra-pulmonary 41.5% , disseminated 21.5%), oral candidiasis 78.5%, herpes simplex 58.5%, PCP 42.5% , herpes zoster 36.5%, molluscum contagiosum 29.4%, infective diarrhea 28.5% oral hairy leukoplakia (OHL) 26.5%, dermatophytosis 26.5%, pyoderma 14.2%, CMV 12.5%, HPV 9.6%, toxoplasmosis 4.5% , scabies 8.5%, cryptococcosis 3.9%, PML 2.5%, bacterial pneumonia 2%, atypical mycobacterial infection (MAI) 1.2% , aspergillosis 0.75%, histoplasmosis 0.03%, penicilliosis 0.03%, amoeboma cutis 0.03% spectrum of malignancies : NHL 3.4%, squamous cell ca 0.1%, adenocarcinoma 0.06 %, kaposi's sarcoma 0.03%, renal cell ca 0.03 %, undifferentiated ca 0.03 %. coinfection with HBV +ve 14.5%, HCV +ve 3.75%, more than one OIs at a given time 49.5%, MDR TB 6.5.%, anti TB drug toxicity 38.5%, more than one episodes of TB 32.5%, annual cost of treating OIs ≈ US $ 2,200.00, number of deaths : 0.49%, ART experienced patients 3.5%, number of PLWA opted for ART 11.5.%, At end of one year follow up ; ART toxicities 19.5%, Immune restoration syndrome (IRS) 5.6%, ART adherence rate 89.5%, ART first line therapy success rate ≈ 97.5%, ART discontinued 4.5%,
Conclusion : Undoubtedly India has advanced epidemic of HIV/AIDS. TB remains commonest OI. Reduced cost and growing awareness about generic availability of antiretroviral drugs are encouraging. Wider use of ART shall be cost effective. Counseling remains key factor for successful management of HIV/AIDS. Periodical CME on ART for healthcare providers essential. Presence of HBV and HCV co-infection complicates ART implementation. Management of HIV-2 infection is interesting.
The 2nd IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
652
Suggested Citation
" J. Maniar, et al.
MANAGING HIV/AIDS PATIENTS IN INDIA - CHALLENGING FOR HEALTHCARE PROVIDERS.
Poster:
The 2nd IAS Conference on HIV Pathogenesis and Treatment:
Abstract no.
652"
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