A study published in the US Journal of Infectious Diseases says that the HIV virus has not been suppressed in a significant number of patients put on Anti-Retroviral Therapy (ART) in India and that there is a need for a second line medication.

It is the largest study that raises the question of how HIV positive patients are faring on ART, says Amita Gupta, assistant professor and deputy director, Centre for Clinical Global Health Education, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore.

An estimated 5.7 million persons live with HIV infection in India. Of these, an estimated 0.7 million have AIDS and require ART. With the aim to assess ART adherence and virologic suppression, a cross sectional study was conducted among 279 HIV-infected individuals who were receiving ART in three private, outpatient clinics in Mumbai.

The study was conducted between December, 2004, and April, 2005, and researchers from the North Carolina Medical centre, Bloomberg School of Public Health, Johns Hopkins University, Baltimore and Human Healthcare and Research Foundation, Mumbai, have reported that 40 per cent were failing their ART.

“The goal was that the virus should be undetectable,”says Gupta. Unfortunately, the HIV viral load test is very expensive (approximately Rs 4,000 per test). The test is rarely done here. In high income countries, the viral load test is done every three months in the first year of the therapy and then every 3-6 months depending on the response and other factors.

Researchers found a detectable viral load (more than 400 copies/ml) in nearly 40 per cent patients. This means that the HIV virus was detected in four out of every 10 patient receiving ART. This suggests that response of many patients was not optimal or they were failing their ART. They found that women were more likely to be suppressed and that family support was important to help them adhere to the therapy.

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