'HEALTHCARE' GIVES FRESH
LEASE OF LIFE TO HIV-HIT
By Rupa Chinai
Times of India (Bombay) 6 June 2001
Many HIV-positive persons have been living without developing symptoms
of AIDS for over a decade now and have been enjoying good health. This
has been possible even without the use of anti-retroviral drugs. This
summation comes from doctors involved in the field of AIDS-care. But
what is most important for HIV-positive persons, according to these
doctors, is a comprehensive healthcare plan -- that is, a treatment
incorporating psychological, emotional, physical and conventional
Nagesh Shirgoppikar, a medical consultant who attends to AIDS patients
at the Salvation Army clinic in Mumbai, feels the importance of regular
medical examination cannot be stressed enough. "Persons testing `HIV
positive' should forget about that label. But at the same time, they
should remember the importance of regular clinical examinations. This
will enable doctors to catch the early signs of opportunistic infections
such as TB or oral thrush, and prevents it through primary and secondary
prophylaxis,'' he says.
The pros and cons of the multi-drug therapy, which has recently become
available at lower prices, should be carefully weighed, advises Dr.
Shirgoppikar. It is only recommended for those who show symptoms of
AIDS, and that too only for those whose levels of CD-4 immune cells in
the blood have fallen below the stipulated mark, he points out.
Incidentally, allopathy offers other options such as immune therapy,
(with drugs like interferon), which is expensive and has limited
exposure in India, he says.
Moreover, the anti-retroviral drugs, once started, require lifelong
continuation of therapy. When infected people stop the therapy, the
Although there is talk of `structured treatment interruption', when the
patient could take a short holiday from the gruelling demands of the
therapy, nobody knows whether it might lead to mutation of the virus
and/or drug resistance, says Dr. Shirgoppikar.
And, although prices for the anti-retroviral therapy have come down, it
could still cost a patient about Rs.4,900 a month. Additionally, a host
of expensive laboratory tests are required every month, to monitor the
CD4 count (the `helper cells' that fight infection) and the impact of
the drug on organs like the liver, kidneys, bone marrow. In addition to
costs, patients need access to reliable laboratory testing facilities
and experienced doctors, who can minimise the adverse reactions of the
drugs through constant monitoring and modification of drug combinations
This line of medical thought was also endorsed by the US federal health
officials recently. US health officials now maintain that there is a
need to delay the use of anti-retroviral drugs as long as possible for
people without symptoms of AIDS. Recent guidelines issued by this panel
marks a major shift from the "hit hard and early'' approach that has
been in effect since 1996. The new approach calls for waiting until the
immune system shows serious signs of weakening, or HIV levels in the
blood exceed the stipulated level.
Delay in the use of this therapy is recommended now because of increased
concerns over the toxic effects of the therapies, reports the New York
Times (February 4, 2001).
Quoting Dr. Anthony Fauci, director of the National Institute of Allergy
and Infectious Diseases, and co-chairman of the panel, the New York
Times report says that delay for up to three years could ultimately
decrease the risk of toxicities. "We are adopting a significantly more
conservative recommendation profile'' that allows the virus to remain in
the body longer in return for sparing the patient the drug toxicities,
according to Dr. Fauci.
The new US guidelines call for delaying drug treatment until the level
of CD-4 immune cells in the blood falls below 350 per cubic milliliter,
instead of the older recommendation of 500. The second change relates to
the HIV blood level as measured by two tests. The panel urged delaying
therapy until the HIV level exceeds 30,000 per mililitre in the
so-called branched DNA test (instead of the previously recommended
10,000) and 55,000 in the so-called Polymerase Chain Reaction test
(instead of 20,000).
Meanwhile, a new booklet, `Positive Health', brought out by a US based
publisher, Metropolitan, presents conclusions based on what the authors
claim are "literally thousands of scientific research studies and
personal experiences''. They provide practical guidelines, aimed at
strengthening the body's immune system, which can help the average
person live effectively with HIV/AIDS.
The authors are Neil Orr, a psychologist who has done extensive research
on the role of nutrition, the immune system and mental-emotional
aspects, and the body's response to HIV/AIDS; and David Patient (who has
lived a healthy life with HIV since the past 18 years). The booklet is
meant for people who have tested `HIV positive' and for those who take
care of them. Without seeking to replace conventional medical treatment,
it recommends simple home remedies for treating common, non-life
threatening physical ailments which occur in HIV infection, along with
useful tips on diet and exercise, how to deal with
stress and emotions, and how to find spiritual healing.
According to the authors, about five people out of a hundred
HIV-positive people do not get ill from AIDS, even 15-20 years after
testing `HIV positive'.