NACO to include third line therapy for drug-resistant HIV patients

In an attempt to reach out to HIV-positive patients who have developed resistant to second line treatment, the National AIDS Control Organisation (NACO) has decided to include third line treatment in its programme.

Third line therapy, sometimes called salvage or rescue therapy, is a term describing treatment regimens for people who have few or limited anti-HIV drug options. This includes people who have failed at least two previous anti-HIV regimens and/or people with evidence of HIV resistance to at least one drug in each of three major classes.

While NACO is in process of procuring the medicines, it has decided to list JJ Hospital as one of the 10 third line treatment centres in India.

Speaking at HIV Congress 2014 in Mumbai, national programme office at NACO Dr BB Rewari said, "A sizable number of HIV patients have developed resistance to second line treatment and we thought that it was high time to make third line treatment available under the programme. The decision has already been taken, but the drug procuring process will take time. The program will should be in place within six months.''

India rolled out free anti retroviral therapy (ART) in 2008, with 7.5 lakh people availing of it in 2014. Of these, around 7,500 HIV-positive people were moved to the second line regimen after developing resistance. "Of these, 250 people are showing resistance to the second line drugs as well,'' said Dr Rewari. However, the government plans to prepare dosages of the third line regimen for up to 1,000 patients.

Apart from introducing third line treatment in the NACO programme, it also plans to double its existing second line treatment this year. "We presently have 54 second line drug treatment centres across the country. We are targeting to scale it up to 100 by this year end. This will ensure that the patients don't have to travel too much to reach the centres," said Dr Rewari.

The third line drugs cost around Rs15,000 per person per month, in contrast to Rs5,500 per person per year for first line and Rs15,000 per person per year for second line drugs.

What is third line therapy?
Third line therapy, sometimes called salvage or rescue therapy, is a term describing treatment regimens for people who have few or limited anti-HIV drug options. This includes people who have failed at least two previous anti-HIV regimens and/or people with evidence of HIV resistance to at least one drug in each of three major classes.

True salvage or deep salvage therapy is when a person has literally no viable treatment options. Treatment failure is a general term that encompasses a number of reasons that a regimen is deemed to be not working. The specific reasons for failure determines if or how the individual drugs in a regimen might be used again as part of a future combination.