India specific guidelines for HIV/AIDs on the anvil

Sapna Dogra - New Delhi

In a new initiative of its sorts, the AIDS Society of India (ASI)- an affiliate of the International Aids Society (IAS)- in collaboration with the National Aids Control Organisation (NACO) and the US Mission is drafting HIV/AIDS treatment guidelines tailormade to Indian milieu and conditions.

The protocols to be referred as NACO-ASI guidelines would chart the ways to contain physical management of HIV/AIDS patients, including their counselling, drug combinations and side effects. NACO, which has welcomed this initiative will help implement these guidelines across the country. The US mission will facilitate the movement of experts from India to the US and vice-versa.

To be compiled in the form of a booklet, the guidelines aim to contribute to improved national and regional responses. The guidelines will be circulated among specialists, as well as general practitioners.

According to Dr Suniti Solomon, president, ASI and director, YRG Care in Chennai, the guidelines are being prepared with the help of international experts, like John Bartlett and Joel Gallent from Johns Hopkins University.

But in the presence of WHO guidelines on the management and treatment of HIV/AIDS, do we need separate guidelines for India? "WHO guidelines are meant for SEARO region and African countries. However, India has certain infections that are region-specific and the disease pattern for HIV/AIDS is also very unique, calling for distinctive guidelines for India," says Dr Solomon.

Agrees Anjali Gopalan, founder, Naz Foundation, an HIV/AIDS and sexual health agency working in South Asia, "Parts of WHO guidelines are not very relevant to Indian scenario. If ASI comes up with specific and precise guidelines for the management of Indian HIV/AIDS, it would usher in rational treatment."

She suggests that ASI-NACO guidelines should guide doctors about the right time to start ARV treatment for paediatrics. "Another problem that need to be addressed is the start of the treatment when the CD4 count is around 300-350. Most doctors in the country start treatment when the CD4 is below 200," she says.

Furthermore, vis-à-vis the A4 sized WHO guidelines which are cumbersome to carry, the ASI guidelines would be a pocket guide, convenient for doctors to carry in coat pockets for quick reference, informs Dr Solomon.

HIV/AIDS has assumed epidemic proportions in most parts of the South East Asia Region, which now accounts for the second highest burden of the disease after Sub-Saharan Africa. And India with its 5.1 million HIV positive people needs effective strategies for the prevention and control of this pandemic.

Says Dr I S Gilada, secretary general, ASI and consultant in HIV medicine, adding, ""We need simple guidelines which should enable all doctors to get involved in HIV treatment management." According to him, India is neither a fully developed country nor it is an underdeveloped country therefore, it is imperative that we have special guidelines as per conditions prevalent here. According to Dr P C Bhatnagar, director-community health, Voluntary health Association of India (VHAI), though this is an excellent initiative, he cautions against the possible misuse of pocket-sized guidelines by quacks and unqualified practitioners giving rise to irrational use of drugs.

sapna.dogra@expressindia.com