As the global efforts to curb HIV-AIDS accelerates, the World Health Organization (WHO) issues new recommendations for countries to address important gaps in HIV prevention and treatment services. The new recommendations advocate using antiretrovirals as an emergency prevention following HIV exposure, and urges prevention and management of common opportunistic infections that affect a large number of people living with HIV.
So, is India on the right path to become an AIDS-free country? Raelene Kambli speaks to Dr Anita Mathew-Davis, Physician & Infectious Disease Consultant, SL Raheja Fortis, Mumbai on the current state, research done so far and ways to overcome the peril
What is the current state of HIV AIDS in India?
In the league table of top 10 HIV affected nations, India is currently the third country with an epidemic proportion. Almost 0.3 per cent of our population, i.e. 2.1 million are reportedly affected with HIV/AIDS. The positive note being that overall we have shown a reduction in the number of patients in the last decade.
What makes Indians more susceptible to acquiring HIV?
According to a study done by All India Institute of Medical Sciences (AIIMS), Indians are lacking in the protective gene and have genes which make them more susceptible to the disease and its rapid progression.
What is India’s contribution towards fighting against HIV-AIDS?
Various programmes are being run by the Government of India through National AIDS Control Society (NACO) that looks into the treatment and prevention of HIV/AIDS. We also have Indian Council of Medical Research (ICMR) and NACO-funded research being done in ICMR, various government medical hospitals and NGOs. These have been successfully implemented and have been major contributors to the reduction in the prevalence.
What are the new roles for emerging economies in fighting HIV – countries such as China, India, Russia, Brazil, and South Africa?
In October this year, South Africa has already confirmed that their trial on HIV vaccine have shown comparable results with more long lasting protection than the trial conducted in Thailand six years back. We might see a vaccine in the market for the same by 2019 if the efficacy and prevention rate is over 50 per cent. In the emerging economies, the ministry of health and other government agencies act either as barriers or facilitators for research ethics approval process.
Where does India stand when compared to these countries in fighting HIV?
India has been doing its bit in the fight against HIV/ AIDS with active support from the government and also by various foundations like Gates and Clinton Foundation which are involved in research.
What is the relation between HIV and tuberculosis? If there is a strong linkage between TB and HIV, how grave is the problem on a larger context, especially in terms of the growing number of people with HIV and TB in India? How can we curb this kind of incidence in India?
We are probably holding the dubious distinction of being the TB capital. We have a huge burden of TB, even in non-HIV individuals. HIV and TB seems to go hand in hand. A HIV-positive with TB co-infection has a 50 per cent lifetime risk of developing TB. The lower the immunity, higher the risk of TB. Various studies have already shown the relation of HIV and TB co-infection. We are facing lot of problems with co-infection which leads to severe drug interaction and increases the toxicity and thus the mortality and morbidity.
Now in addition, we are also dealing with multi drug-resistant/ extensive drug resistance and off-late, total drug-resistant TB cases. These will have a huge burden on our existing health resources besides increasing the mortality. Early detection and judicious evidence-based treatment of TB patients in the population will be a positive step towards reducing the incidence.
Some experts claim that India is close to getting some leads for developing a vaccine against HIV that causes AIDS. What is your opinion on the same?
Researchers from HIV Vaccine Translational Research Laboratory in India have said that once they are able to isolate the neutralising antibodies in patients who are infected but have not progressed to the disease, they would have a clear understanding of how to go about with vaccine development.