CNS: ASICON2013

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Surgeons championing the cause of treating people living with HIV

Despite evidence to prevent occupational exposure to HIV for surgeons and other healthcare providers, people living with HIV (PLHIV) requiring surgical procedures for treatment often face heightened stigma and get discriminated within healthcare settings. But all is not that black and there are surgeons who have championed the cause of treating PLHIV without stigma and challenged discrimination in healthcare settings as well. Few of these surgeon-heroes were sharing their experiences of over 20 years in treating PLHIV at the 6th National Conference of AIDS Society of India (ASICON 2013).

"Co-infections and HIV beget each other": Dr Dilip Mathai

(This article is based upon a CNS interview with Professor (Dr) Dilip Mathai, Dean, Apollo Institute of Medical Sciences and Research)

Dr Dilip Mathai (left): ASICON 2013

HIV in today's context is a chronic condition of the human immune system. HIV is a retrovirus and the infection leads to a progressive reduction in the number of CD4+ T-helper cells (so called because CD4 glycoprotein is found on their surface) which are an essential part of the human immune system. They are the main targets of HIV which destroys infected CD4 cells leading to an overall weakening of the immune system, said Dr Dilip Mathai, Dean, Apollo Institute of Medical Sciences and Research, and former Head of Medicine Department, Christian Medical College (CMC), Vellore.

A study found that prevalence of human papilloma virus (HPV) among women living with HIV was 26.85% which was much higher than the HPV rates in HIV-negative women. Dr Ankita Chourasia, a researcher from Banares Hindu University (BHU) whose oral presentation of this study was awarded at the 6th National Conference of AIDS Society of India (ASICON 2013), strongly recommended regular HPV screening for women to cut down rates of HPV-caused cancers such as cervical cancer. HPV is the most common sexually transmitted infection (STI).

AIDS is just one of the manifestations of HIV, said a veteran health advocate. A range of co-infections and co-morbidities also need as much attention as AIDS-related treatment and care. HIV and hepatitis B virus (HBV) co-infection was in spotlight at the 6th National Conference of AIDS Society of India (ASICON 2013). HBV is a viral infection that attacks the liver and can cause both acute and chronic disease. Mode of transmission of HBV and HIV both are similar: they get transmitted through contact with the blood or other body fluids with high viral load of an infected person. About 600,000 people die every year due to the consequences of HBV.

To tackle any disease it is not merely only diagnosing correctly and offering quality treatment but ensuring that the patients adhere to treatment that is of paramount importance. Timely and correct diagnosis and availability of standard, evidence-based and effective treatment cannot be of much help unless the patient takes the prescribed drugs for the complete duration of time. So over and above everything else it is the patients' willingness and determination to take their medicines regularly that can bring relief.

An estimated 3.4 million children are living with HIV, thus accounting for 10% of the total global HIV infected population. At the same time, the number of children newly infected with HIV dropped drastically by 52% between 2001 and 2012. And yet as per the UNAIDS Global Report 2013 currently only 34% of children under 15 years of age in need of antiretroviral therapy (ART) in the world are actually receiving it. This is just half of the ART coverage for adults. To reach the goal of an AIDS-free generation we have to focus on elimination of HIV in children.

Although historic scale-up of antiretroviral therapy (ART) is keeping people living with HIV (PLHIV) alive, 1 in 10 of them succumb to cardiovascular diseases (CVDs). “The good news is that survival of PLHIV has improved, but CVD is increasingly becoming one of the important causes of morbidity and mortality” said Dr K Naik of Lokmanya Tilak Municipal Medical College (LTMMC), Mumbai. Dr Naik was speaking at the 6th National Conference of AIDS Society of India (ASICON 2013).

On one hand the new mantra of ‘zero new HIV infections, zero deaths and zero AIDS-related stigma and discrimination by 2015’ is increasing decibels and on another hand Indian AIDS response is dealing with a complex matrix of challenges impeding programme outcomes. To compound the situation there are policy conflicts against public health such as the Supreme Court’s decision to re-criminalize same sex behaviour that further will slow down the AIDS response in the country (as men who have sex with men and transgender people are HIV key affected populations as per the government’s National AIDS Control Organization).

One size does not fit all. Likewise we need an expanded basket of evidence-based interventions and approaches to meet the unique needs and contexts of different key affected populations to prevent HIV. Deliberations on the first day of the 6th National Conference of AIDS Society of India (ASICON 2013), discussed amongst other things, effective strategies for HIV prevention and control.

The 6th National Conference of AIDS Society of India (ASICON 2013) which has brought together over 700 HIV medical experts from across India with a distinguished national and international faculty opened in Mumbai. Dr IS Gilada, President of the conference and also of AIDS Society of India (ASI), said: “to strengthen south-south collaboration between Africa and India and to promote mutual information exchange and learning in fight against AIDS, ASICON 2013 is being inaugurated by Minister of Health from Tanzania.”

Shobha Shukla - CNS
Mumbai will be host to the 6th National Conference of AIDS Society of India (ASICON 2013) from 13th to 15th December. As its theme HIV/AIDS: Scaling New Heights – From Prevention & Treatment …Towards Cure suggests, the conference will focus on vital issues in the journey of the HIV epidemic from prevention and treatment towards possible cure. 45 national and 25 international eminent speakers are expected to share their expertise on a variety of subjects during this 3 day long event, informed Dr IS Gilada, President, AIDS Society of India.