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 medical treatment.

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 virus rebounds.

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 and dosage.

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'.