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HIV Situation in India
Dr Sunil Gaikwad
HIV/AIDS In India
Approximate population of India: 1.21 billion (Census 2011 )
1986: First case of HIV detected in Chennai Estimated number of HIV/AIDS cases in India (2009) :
2.39 million [Females- 39% and children- 3.5% ] Adult HIV prevalence: 0.31% 10% of the world's HIV/AIDS population live in India New annual HIV infections has declined by more than
50 percent during the last decade, 2.7 lakh in 2000 to1.2 lakh in 2009.
Majority of infected individuals are in 15 – 45 yrs age group, Male-female ratio – 2 : 1
Every year in India, over 100,000 pregnant women with HIV give birth NACO Annual report 2010-112
High prevalence states
NACO Annual report 2010-113
Four south Indian states Andhra Pradesh
Maharashtra Karnataka and Tamil Nadu Contributes 55% of all
HIV infections
Routes of Transmission of HIV, India, 2010-11
NACO Annual report 2010-114
NACO Annual report 2010-11
National AIDS Control Programme Phase III (NACP III) 2007 - 2012:
Halt and reverse the epidemic in India by 2012 Reduce new infections by
60% in high prevalence states 40% in vulnerable states
Increase proportion of PLHA receiving care, support and treatment
Strengthen the infrastructure, systems and human resources in prevention, care, support and treatment programmes at district, state and national levels.
Build strategic information management systems
India’s response to the epidemic
NACO Annual report 2010-116
ICTC
7
Voluntary HIV testing with appropriate pre-and post-test counseling
Confidentiality
No Test & Treat Approach
ART in India
NACO Annual report 2010-118
Free ART roll out programme – Dec 2004
Current status [Jun 2011] ART centers - 313 PLHA receiving ART from Govt -
428638 including 25071 children ,
PLHA receiving ART from private sector- approx1,50,000.
COE: providing second line ART : 10 centres of excellence and covers 1929 patients
PLHA registered : 40 % of the estimated 2.39 million pts. have been identified and registered in ART clinics across the country
ART scale up in India
NACO Annual report 2010-119
Antiretroviral drugs available in India (2011) NRTIs
Zidovudine Stavudine Tenofovir Lamivudine Didanosine Abacavir
NNRTIs Nevirapine Efavirenz
PIs Atazanavir Lopinavir/Ritonavir Darunavir Indinavir Nelfinavir
Integrase inhibitors Raltegravir
10
Antiretroviral drugs available free through the public health care delivery
First line antiretroviral therapy (therapy naïve) Zidovudine/Lamivudine/Nevirapine Stavudine/Lamivudine/Nevirapine Zidovudine/Lamivudine/Efavirenz Stavudine/Lamivudine/Efavirenz Tenfovir/Emtricitabine/NVP or EFV*
Second line antiretroviral therapy (treatment experienced) : Zidovudine/Lamivudine/Tenofovir/Atazanavir/
Ritonavir11 * Alternative first line therapy
NACO Guidelines 2007
Preferred regimen AZT + 3TC + NVP
Alternative regimen AZT + 3TC + EFV d4T + 3TC + NVP/EFV
Other options TDF + 3TC/FTC + NVP/EFV PI’s not recommended for first line therapy
12
CRITERIA FOR STARTING ANTIRETROVIRAL THERAPY
13
NACO 2009 WHO 2010
14
Classification ofHIV-
associated clinical disease
WHO STAG
E
CD4 NOT AVAILAB
LE
CD4 AVAILABLE
Asymptomatic 1 Do not treat
Treat if CD4 <250
Mild symptoms
2 Do not treat
Advanced symptoms
3 Treat Consider treatment if CD4 <350and initiate ART before
CD4drops below
200
Severe/advanced symptoms
4 Treat Treat irrespective of
CD4 count
Classification ofHIV-associated clinical disease
WHO STAGE
CD4 AVAILABLE
Asymptomatic 1 CD4 <350 /mm3
Initiate ART
CD4 > 350/mm3 Defer unlessHBV/HCV Rx HIV nephropathyCytotoxic therapy
Mild symptoms 2
Advanced symptoms
3Treat
irrespective of CD4 countSevere/advanced
symptoms4
Challenges
15
Low Health seeking behavior Stigma Diagnosis of OI
Early diagnosis of PTB & EPTB in HIV Diagnosis of MDR and XDR tuberculosis among PLHA
First line ART Raising cut of for ART initiation to CD4 350 cells cu
mm. Need for introduction of viral load, drug resistance
and TDM in the ART programme. Resistance to first line ART drugs
PMTCT- Single dose NVP
Thank you