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

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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

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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

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CRITERIA FOR STARTING ANTIRETROVIRAL THERAPY

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NACO 2009 WHO 2010

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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

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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