Are HIV patients being misled?
WORLD AIDS DAY Study reveals results produced by the CD4 count are unreliable, the patients also have high viral load
MUMBAI: A study conducted by doctors from KEM Hospital, Parel, along with Medecins Sans Frontieres/doctors Without Borders, an international non-governmental organisation (NGO), revealed that some human immunodeficiency virus (HIV) patients might have been misled into believing that their condition is stable.
The doctors subjected 2,246 HIV patients, irrespective of their immunity status, to the crucial viral load test. The test revealed that 8% of patients, who had a high CD4 count — an indicator good immunity — had a high viral load as well. The viral load test reveals the numbers of HIV virus particles in the blood, which reveals the stage of infection. Doctors said viral load is a more sensitive test compared to CD4 count.
“An indication of good immunity may not always mean that the virus particles are dying in the body. This is the reason why performing viral load test, alongside CD4 count, is crucial,” said Dr Reena Verma, a city-based HIV physician.
In 2013, the World Health Organisation (WHO) released guidelines ‘recommending’ that all patients on antiretroviral therapy (ART) must undergo viral load test, to find out the status of their infection. But in India, under National Aids Control Organisation ( NACO), HIV patients who are on first line ART are monitored on the basis of CD4 count. The doctors said results from this test an unreliable.
Dr Naresh Gill, a part of the international NGO), who led the study, said the 8% patients, who showed high CD4 count do not need to undergo viral load tests as per the NACO policy.
“With high CD4 count, and absence of routine viral load results, such patients will think that the treatment is working fine. But in the coming months, they will fall ill because the virus is multiplying,” he added.
HT spoke to an HIV patient, who was refused a viral load test at a government centre because he had a high CD4 count, suspects he has developed resistance to the ATR .
“Though my CD4 is good, I started feeling weak and lost weight. I suspected an increase in viral load. I have been turned away several times [from government centers] when I asked for the viral load test . If the test is done routinely, doctors will be able to decide further course of treatment”, the patient said.
Dr Srikala Acharya, additional project director of Mumbai District Aids Control Society (MDACS), a body that implements NACO, said 8% is not a huge number when compared to the total number of HIV patients who were tested. “But NACO has said that by the end of next year, routine viral load test will be included in the programme,” Acharya added.
Dr RS Gupta, deputy director general, NACO, confirmed that the number of machines to test viral load will be increased by 2018 using money from Global Fund. To highlight the issue, members of Mumbai AIDS Forum (MAF) — formed by 30 NGOS — visited MDACS office in Wadala on Thursday demanding health ministry to conduct routine viral load test.
“Viral load test measures the stage of HIV infection and is the best way for health workers to understand if patients are responding to ART or have developed resistance, so that the treatment can be changed. Lesser the HIV infection in a person’s blood, the less likely they are to pass on the virus”, said Poonam Patkar, project director Committed Communities Development Trust, currently having secretariat, MAF.
An indication of good immunity may not always mean that the virus particles are dying in the body. This is the reason why performing viral load test, alongside CD4 count, is crucial.
DR REENA VERMA, HIV physician