World Aids Day: When drugs stop working on HIV....

Armed with three empty pill bottles, Khem Chand (48) is seen sitting in a queue of hundreds of patients at Lok Nayak Hospital’s Anti-Retroviral Therapy (ART) centre. Chand realised that he was HIV positive in 2007. Since he has been on medication that has stopped working twice around. 

Chand is harrowed as he is on third-line drugs. “What if I develop resistance to these now? There is no drug which can keep me healthy. I am hanging on to my last hope now,” he says. 

Chand is one of the 125 patients registered on third-line HIV drugs. “India has 12,22,165 HIV-infected persons registered on its rolls of which 9,97,869 patients are on medication. Up to 15,500 patients are on second-line drugs. We have 125 patients registered under third-line treatment as of September 2016 figures,” said Dr. RS Gupta, Deputy Director General, National AIDS Control Organisation. 

Chand’s health has only deteriorated since 2007. In 2012, first-line drugs - Tenofivir, Lamivudine and Efavirenz, that he was consuming since five years stopped working. “I developed high fever. My CD4 count dropped precariously. I was put on second-line drugs which was a combination of Tenofivir, Lamivudine, Ritonavir and Atazanavir,” he recounts. CD4 is a glycoprotien found on surface of immune cells and is an indicator of an HIV-infected person’s health. Chand did not take well to second-line drugs. “I developed terrible drug reactions. I had rashes all over my body,” he says. 
During this time, he also developed tuberculosis (TB) in the stomach. 

A note dated October 30 in 2014, by the referral doctor at Lok Nayak indicates that Chand had failed on second-line treatment. “Now I desperately needed third-line drugs. Doctors told me that third-line drugs were unavailable in government set-up. In spite of my failure on second-line drugs, I was kept on second-line medication for over a year,” recounts Chand. Later in December, another note states that Chand’s CD4 dipped as low as 54. His viral load had shot up to 13, 9000 copies per ml and doctors were worried about his deteriorating health. The third-line drugs namely a combination of Raltegravir, Darunavir and Ritonavir, the latter two of which are now manufactured from Pune  

While Raltegravir which is imported from Netherlands costs up to Rs 10,000 for sixty tablets, Darunavir and Ritonavir, manufactured from Pune cost another Rs 10,000. “The MRP price in private chemists for these drugs was over Rs 20,000. I could not afford it,” says Chand. Last year, Chand and two other patients moved Delhi High Court against the Union Health Ministry for not making costly third-line drugs available for free under the National AIDS Control Programme. “It was only after repeated petitions and hearings that the government has made these drugs available for free five months ago,” said Chand. 

Last year, Chand was re-infected with TB, this time in the lungs. Lately, he has also developed a tumour above his left kidney. 

In 2001, when Chand was operated for Piles, he remembers having a blood transfusion, which could have been faulty and infected him with HIV. 

Another 45-year-old patient, Shyam (name changed) who is on third-line drugs was diagnosed with drug-resistance a year ago. “I had been reduced to a skeleton. Government doctors said I will have to arrange medicines from a private chemist. I took loans to pay for my medication, up to Rs 20,000, a month. From here on, if these stop working there is no option ahead of me,” he said. 

A doctor from the ART centre said, “We see close to 7000 ART patients in Lok Nayak. Of these close to thirty are on third-line drugs since over a year. Many who did not receive the drugs have suffered incessantly. One even died due to deadly co-infections.”

Doctor notes showing II line failure.

Doctor notes showing suggestion for III line drugs.