Gilada I, Bodhare S; International Conference on AIDS.
Int Conf AIDS. 2000 Jul 9-14; 13: abstract no. TuOrB296.
I. Gilada, Unison Medicare & Research CentreMumbai 400007, India, Tel.: +91-22 306 16 16, Fax: +91 22 300 00 16, E-mail: gilada@usa.net; ihoaids@vsnl.com
Background: Though ARV have produced dramatic impact on morbidity/mortality of PLWHA in industrialised countries,the situation in resource-poor settings is grim as ARV cost is prohibitive.They are gullible and exploited by fake claimants.Some manage to collect ARV costs through family support/borrowings. Despite counseling on ARV not being curative, under illusion of cure PLWHA, initiate therapy. When continuing HAART become unmanageable,demand for cheaper options surface. Methods: Over 2800 PLWHA were managed and followed up prospectively from 1995-99. Only 140(5%) could afford ARV treatment from 1998.Others were given prophylaxis or treatment for OIs, if and when required. In gr.A, 48 were on 2 NRTIs,1 PI (Indinavir). In gr.B 52 were on Hydroxyuria(HU) 500 mg daily, d4T,3TC- all are locally manufactured at 20% of international cost. The parameters of CD4 count, clinical status and incidence of Ois were applied. Few could afford plasma viral load and CD4 counts in second group. The patients were followed up bimonthly. Results: There was no significant difference in weight gain,incidence of OI, survival and gain in CD4 count at one year(mean gain 160 v/s 129) in both regimens. In A, gain in mean CD4 count was 80% (199 to 359), in B it was 79% (163 to 292). There were no major adverse events, except that of three patients getting lypodystrophy in A and one developing severe anaemia in B. The only two deaths from A were in vehicular accidents. Conclusions: Despite using a low cost, PI sparing regime there was no difference between two groups.Lowering HU dose due to black nail syndrome,reduced side-effects without affecting mortality/morbidity. Mean monthly cost was $380 in A and $105 in B. It appears that HU regime gives similar, if not better, results. The findings are vital in view of impending cost escalation after enforcement of GATT and TRIPs agreement. Compulsory licensing of ARV may provide relief to PLWHA for which we need to put a united front.
Publication Types:
Keywords:
- Antiretroviral Therapy, Highly Active
- CD4 Lymphocyte Count
- Counseling
- Health Resources
- Humans
- Incidence
- Morbidity
- Poverty
- Viral Load
- drug therapy
- therapy
Other ID:
UI: 102238978
From Meeting Abstracts