Indian government has no plans for second-line antiretrovirals
18 December 2006
The Alliance in India has supported an appeal to the country’s highest authority on HIV and AIDS to provide second line therapy as evidence mounts that people in India will soon be dying because they cannot access second-line antiretrovirals under the government’s free treatment programme. Although there are no official estimates of numbers of patients who have developed resistance to first-line drugs*, anecdotally people with HIV are now reporting treatment failure.
Second-line therapy is unavailable free of charge in India because of the high costs involved. In a recent letter to the Alliance’s implementing non-governmental organisation, Child Survival India (CSI), the National AIDS Control Organisation (NACO) confirmed it was unable to provide second-line drugs on account of their high cost. The agency offered no guarantees that it would be providing access to second-line therapy in the future.
CSI had written to NACO – the country’s highest authority on HIV and AIDS – in order to take up the case of a patient, Ram, who needs the life-saving drugs but is unable to afford the high cost of the medicines. CSI also urged the agency to undertake all necessary steps, including political and policy actions, to ensure uninterrupted treatment to people living with HIV.
Ram has been on first-line antiretrovirals since April 2002. His family has been enrolled in the Alliance India-supported Home and Community-Based Care and Support (HCBCS) programme in Delhi. Last year, Ram used a small loan provided by the HCBCS programme to start operating a telephone booth, which brings him an average monthly income of Rs 2,000.
However, he has been reporting recently a steady and visible deterioration in his health. He is suffering from chronic diarrhoea and weight loss. He is also experiencing loss of vision, which doctors’ suspect is an opportunistic infection of the retina. In May this year, Ram’s CD4 cell count dropped to 52.
According to his doctors, he is presenting signs of treatment failure and is now in need of second-line antiretrovirals. The medicines that will keep Ram alive cost anywhere between Rs 5,000 to 8,000 a month (depending on the combination), a price that is almost four times what he earns.
The Government of India has been rolling out free antiretroviral treatment to people with HIV since April 2004. Those with a CD4 count of less than 200 and/or those manifesting symptoms of AIDS are enrolled at antiretroviral treatment centres in participating government medical colleges and hospitals across the country. These centres provide a triple combination of first-line drugs.
Currently, 43,000 people are receiving first-line treatment under the national programme, a figure way short of the estimated 100,000 people in need of treatment. But until the government acts effectively on second-line antiretroviral prices too, and the International Drug Purchasing Facility (IDPF) and UNITAID get off the ground, people like Ram will continue to die not of HIV but for want of drugs.
* Currently, antiretroviral treatment centres do not monitor drug resistance, and markers for treatment failure in patients such as viral load and CD4 cell count are not standardised.
Senior Policy Officer, Alliance India