Breakthrough in AIDS battle: How relevant for India?

Many leading US publications (including WSJ and NYT) have headlines screaming about a breakthrough result from a large clinical study on HIV/AIDS that could potentially turn the epidemic on its head. On Thursday researchers said treating infected people with anti-retrovirals (ARTs or standard AIDS drugs) very early on stops infection transmission by almost 96 percent. They found the results so astounding that they announced it a few years before the completion of the study, which has been conducted on 1763 couples across several countries, including India. The fact is, this has long been suspected and documented, albeit less rigorously, or should we say in a less glamorous manner? Doctors and researchers in India say they’ve known this all along but they just can’t practice it. First of all, early HIV detection is a problem as the disease still carries a lot of social stigma. Secondly, once the therapy is started, doctors don’t know when to stop, it could become a lifetime regimen. This has two issues: expense and side-effects. [caption id=“attachment_10091” align=“alignleft” width=“380” caption=“A new study on AIDS claims that early therapy can curb transmission.  Suzanne Plunkett/ Reuters”]  [/caption] Talking of cost first: Indian government under the National AIDS Control Programme provides free ARTS through its NACP III, which is heavily supported by international donors who have already indicated their cuts due to tough global economic conditions.  Studies have also shown that this model of financing for India’s AIDS control programme is not sustainable. In such a scenario, starting ART even earlier, though desirable to some extent, isn’t feasible. “Even if this study confirms what is known already, how do we decide how long to give the ART—six months or one year? After stopping, if the viral load increases again, then what do you prescribe: second line drugs that are more expensive or first line drugs which probably have led to resistance in the virus? In wealthy patients we can still start early, stop, and then resume next-generation drugs if the infection returns, but this can’t be done for the average Indian AIDS patient,” says a doctor who is part of the NACO programme in the North-East and doesn’t want to be named. The costing pressure on NACO is already high since 3-5 percent of AIDS patients in India need second line of ARTs that are about 8-10 times more expensive than the first line of drugs. And we aren’t even talking the third line of drugs and other newer medicines. According to a modeling study in Health Affairs, the highest estimate for India’s HIV/AIDS fund requirement by 2031 is pegged at $2.4 billion. So, if “treatment as prevention” is what the new study is championing, then it’s both thumbs up and thumbs down to it. Up, because theoretically it looks very promising, as a preventive vaccine is still a few years away. Down, because implementing early, universal ART availability is nearly impossible, even though HIV/AIDS is the best-funded disease (compared to those like cancer that is killing more worldwide), in history.