World AIDS Day 2015: A new dawn for HIV treatment

The theme of World AIDS Day 2015 is “Getting to zero; End AIDS by 2030” in unison with the fast track strategies of UNAIDS to end the epidemic of HIV infection by the year 2030. As the federal theme states “The time to act is now” for us.

Devising new health strategies for 2016-2020, World Health Organization (WHO) has recently recommended antiretroviral therapy (ART) right at the time of diagnosis to every single person who gets HIV infection. The current strategy is to treat HIV infected people only when they develop symptoms of AIDS as the infection progresses. WHO also recommends that every individual who is at the risk of exposure to HIV should be given prophylactic antiretroviral therapy. This initiative is a very rigorous step towards proactively containing an infection affecting more than 37 million people worldwide. It is estimated that approximately two million people get newly infected every year. The new strategy brings in an additional 9 million people into antiretroviral eligible category from the existing number of 28 million.

WHO is a co-sponsor of Joint United Nations Programme on AIDS (UNAIDS) which has put forth the recent recommendations hoping to prevent nearly 21 million AIDS related deaths by the year 2030. Current strategies, though meant to address 28 million patients, reach only to 15 million HIV infected people worldwide due to the global challenges in treatment. Not every set of population has accessibility to treatment options. As most of the countries offer antiretroviral therapy free of cost, treating huge numbers of people is a humungous financial burden on governments. Moreover, lack of awareness and social stigma prevent many from seeking help when in need.

UNAIDS has also put forth strict management guidelines to address HIV-TB co-infection as well as to eliminate feto-maternal transmission of HIV. FDA approved treatment modalities available are combination therapies of Nucleoside Reverse Transcriptase Inhibitors (NRTIs), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), Protease Inhibitors (PIs), Fusion, Entry, Integrase Inhibitors along with Pharmacokinetic Enhancers.

The Union Government of India bears an average cost of Rupees 28,500 to treat one patient with ART. Citing economic constraints, government had strict inclusion criteria for treatable cases. But, after the Supreme Court of India directive to treat every HIV positive patient with complete ART in December 2010, based on “Right to Life” guaranteed by Article 21 of Indian Constitution, it is mandatory for public and private medical sectors of India to offer ART to all patients irrespective of the severity of infection. National AIDS Control Organization (NACO) provides antiretroviral therapy to patients in India through its 91 centers. Though NACO statistics report approximately 2.5 million HIV infected people in India, only 85,000 people receive supervised ART through NACO Centers. This is a major health concern for India.

Health Department of Kerala has set up 36 “Jyothis”- Integrated Counseling and Testing Centers (ICTC) across Kerala to test, counsel and give expert referrals to people free of cost. “Ushus”, supported by NACO, are centers in the Department of Internal medicine at all Medical Colleges of Kerala providing ART free of cost to all HIV positive patients in the state. Kerala is the first state in India to provide free ART to all HIV patients through 42 “Ushus” centers.

Let us all hope the new initiatives by WHO and UNAIDS will help contain this dreadful infection and make human race healthier in near future.