It is imperative that every healthcare professional working in the field of HIV/AIDS have adequate training on HIV/AIDS clinical care – its epidemiology, pathogenesis, good laboratory practices and a humane approach to dealing with the concerns of stigma that the HIV positive patient may face. Raelene Kambli catches up with Christine Bowtell-Harris, Clinical Nurse Specialist at Melbourne’s Alfred Hospital, Adele Lee-Wriede, Supervising Scientist at the Melbourne-based Clinical Research Laboratory Centre for Virology, and Alison Duncan, Senior Clinical Pharmacist, at Melbourne’s Alfred Hospital who recently conducted a national programme on HIV/AIDS and antiretroviral therapy in association with CII and the Australian India Council. The clinical session acted as a platform for medical professionals to know more on the subject. Excerpts…
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Christine Bowtell-Harris
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Adele Lee-Wriede
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Alison Duncan
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What is the current status of HIV/AIDS globally and particularly in India?
There are approximately 34 million people in the world living with HIV and 2.4 million in India.About 50 per cent of those infected with HIV are women. In India, the epidemic started later than in many other parts of the world and initially the focus was on sex workers and truck drivers. Now, the HIV epidemic affects all parts of the Indian society.
Why is it so difficult to cure HIV and AIDS? What are the treatment options available to Indians?
HIV is an unusual virus. In an infected person the HIV replicates in immune cells and during replication it changes its genetic material. This means the immune system is always “on the back foot”- it cannot keep up with the changing virus to control it. So antiretroviral therapy (anti-HIV drugs) are needed to try and slow down HIV replication so that it is present in very very low levels in the blood and organs. Then the damage to the immune system caused by HIV is so minimal that people on treatment can live a normal life span. India is incredibly fortunate as it has a number of companies, e.g. Cipla, that make drugs to treat HIV. So excellent treatment is available and at a fraction of the cost than in countries like the US. There is currently no cure for HIV. Research to find a cure is still at a very early stage.
What is antiretroviral therapy? How is it helpful in treating HIV/AIDS?
Antiretroviral therapy is a treatment that suppresses HIV to undetectable levels in the blood and organs. If people with HIV, who have evidence of some damage to their immune system are prescribed antiretroviral drugs then they must take them without missing a dose. Missing doses, even one pill per month, can result in the development of resistance so that the drugs don’t work. Taken regularly, the drugs stop the virus from replicating and thus keep the immune system healthy so that people don’t get AIDS. This means that they can potentially have a normal survival. A young man aged 20 years old with HIV who starts treatment and doesn’t miss doses of his pills can expect to live until he is about 70 years old.
Is antiretroviral therapy the only treatment available for HIV/AIDS? And what are the benefits of antiretroviral therapy over other available vaccines?
There is no HIV vaccines that works at present although there is an ongoing research happening in this sphere. The drugs can prevent AIDS from developing and prevent people from dying: no vaccine can do this.
Are there any precautions that need to be taken before initiating antiretroviral therapy? Are there any side-effects associated with this therapy?
Before starting antiretroviral therapy the HIV+ person should have a blood test to make sure he/she fits the Indian government criteria for treatment. It means taking a CD4 test which shows that there has been some damage to the immune system. It is particularly important that if any pregnant woman seeks medical advice to see if she has HIV infection and then receives appropriate treatment then her baby can be protected from HIV infection. Many people do not know that they have HIV infection as some people have no symptoms until significant immune damage has occurred. Every drug potentially has side effects and antiretroviral drugs are no exception. The benefits of antiretroviral drugs generally outweigh the risks of side effects. Many harmful side effects can be prevented by careful monitoring in the clinic.
Today, experts around the world speak of highly active antiretroviral therapy. So is this therapy available in India?
Yes, highly active antiretroviral therapy is available in India and is the usual treatment that is provided when HIV treatment is advised.
How is highly active antiretroviral therapy better than antiretroviral therapy?
Highly active antiretroviral therapy or HAART is a combination of drugs and it has been shown that resistance to HIV is less likely when a combination of drugs is used. This is the same for TB treatment. HAART is even available in a single pill (that is three drugs in one pill) to save the person from taking multiple pills.
Are we any close to finding a complete cure for HIV/AIDS?
While we hear about seeking a possible cure for HIV we should acknowledge that this is a long way off and indeed may never happen. Instead we should reflect on how well we can control HIV infection these days with highly active antiretroviral therapy. HIV is just like diabetes: good treatment is available and that can keep the person healthy for life. India is particularly fortunate in having excellent pharma like Cipla who produce these drugs at a fraction of the cost and as a result have dramatically reduced mortality from HIV infections in resource limited countries around the world.
Moving forward, please tell us about your reason to visit India?
We were here to conduct capacity building clinical care session in collaboration with the CII, Indian Business Trust for HIV/AIDS (IBT) and the Australia India Council (AIC) for medical professionals to enhance their skills while providing care and treatment to people living with HIV/AIDS.
So please tell us more about the programme and its key focus areas?
The programme was conducted to bring together the medical professionals on a common platform to learn from each other’s experiences in dealing with the issue of HIV/AIDS, to provide an interactive and educative environment to discuss various issues related to the treatment of HIV/AIDS patients.
Topics covered over the one day programme included the epidemiology and pathogenesis of HIV, basic anti-HIV treatment, opportunistic infections, HIV infection and laboratory tests for HIV monitoring, medication counselling, psycho-social issues, HIV in pregnancy, post exposure prophylaxis and universal precautions.
What was the response you received for the programme?
We received a very good response. What we felt is that doctors, nurses and other medical professionals are very interested in learning more on how to provide better care to people living with AIDS.
You having been conducting this programme in India since 2003. What are the changes that you have seen in treatment available and perspective of people toward AIDS?
The outlook of people in India is changing. They have become more aware about the disease and are socially excepting people living with AIDS. I will say that this credit goes to the Government of India and the healthcare professionals from the country who have taken continuous measures to bring down the toll and especially in creating more awareness. Creating awareness is the key to bring down HIV/AIDS within any country.
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