05 March 2004	Friday	13 Muharram 1425

KARACHI, March 4: Viral load assessment facility and CD4 (Cell Count) Test, a prerequisite for timely diagnosis HIV, are not available in any of the public sector hospitals across Sindh.

Dr Sharaf Ali Shah, Programme Manager of the Enhanced HIV/AIDS Control Programme for Sindh, said here on Thursday. He was responding to queries by local doctors and an American expert during a presentation at Dow Medical University (DMU).

The facility is available only at Aga Khan Hospital for which an amount of Rs12,000 is charged. A majority of people obviously cannot afford the cost. Dr Shah, however, observed that the concerned authorities were fully conscious of the fact and that assistance from the Sindh Institute of Urology and Transplantation (SIUT), well equipped to undertake a wide range of viral load tests, would be sought soon.

Talking to APP after the presentation, Dr Shah said that kits, costing not more than Rs100,000 to Rs 200,000, for the CD4 and viral load assessment tests, would be provided to the SIUT for making the procedure workable and this could be arranged under the Enhanced AIDS Control Programme in the next two months.

He hoped that all arrangements for such diagnostic procedures would be made to facilitate the programme by end of the current year. Dr Shehla Baqi, the guest speaker at the presentation, in her paper on Treatment of the HIV Infected Patient stressed that bottom line of transmission is viral load, adding that more the viral load, more are the chances of transmission of infection.

In this context, she referred to studies which showed that viral transmission through blood appeared 100 per cent. In case of physical promiscuity, she added, chances of HIV transmission through male-to-female contact were more.

These factors hold particular relevance to Pakistan where faulty blood transfusion system coupled with high prevalence of intravenous drug addiction, instances of needle prick injury and vulnerability of unassumed wives are considerably high.

Dr Baqi, explicitly discussing the Highly Active Antiretroviral Therapy (HAART) said that clinically it was aimed at prolongation of life and, more importantly, the life quality.

Virologically, it was said to be reduction in viral load ultimately delaying the worse; and Epidemiologically, to reduce HIV transmission.

Therapeutic aspect of the HAART is the most significant as it not only helps maintain therapeutic option and minimize side-effects and toxicity, but also to maximize adherence.

Strict and absolute adherence to prescribed drug therapy, the speaker said, was extremely essential to make it propitious for the patients as otherwise they could developed resistance to the drugs.

She underscored need for easy and constant availability of drugs. This, however, was questioned by Pakistani doctors who referred to the situation where antiretroviral agents are not easily available in the country compelling many of the concerned physicians to opt for a 'stop-start' strategy in accordance with the availability of drug or shifting from one class of drug to another one with enhanced risk of resistance among the patients.

The speaker said that constant progress was being made in the field of antiretroviral agents over the past several years and patients were now provided with options with comparatively little side-effects, minimum possible complications and, above all, quality as well as prolongation of life.

With regard to the Entry Inhibitors, commonly known as 'Fuzeon', she said this was the newest agent meant to prevent HIV from entering healthy CD4 cells. She, however, mentioned that being injectable and with low rate of compliance among patients are not very frequently recommended.

Acknowledging that the issue of antiretroviral agents had to be efficiently addressed, Dr Shehla Baqi stressed the need for proper education of those on drug therapy and mobilizing them to ensure compliance to the said procedure for their own good.

Due consideration was further suggested on the part of physicians to go for one single combination of antiretroviral agents instead of varied classes.

The speaker also emphasized the importance of monitoring therapy and said that after starting or changing therapy, the number of the CD4 cell count might increase by 50 cells within four to eight weeks.

With regard to the cost to antiretroviral therapy, she said it came to around $20,000 per year and if complimented by the Entry (fuzeon) Inhibitors, the cost would come to $40,000. The last of the therapies, she said, was not a feasible option due to poor compliance on the part of patients.

Earlier, Dr Sharaf Ali Shah, in his presentation mentioned that of the 40 million people with HIV/AIDS, about 70,000 to 80,000, 82.2 per cent of them being men, were estimated to be in Pakistan. Majority of the patients fell in the age group of 20 to 40 years.

Deported Pakistan workers from gulf countries were said to constitute 70% of the 2086 reported cases of the disease. He maintained that in the backdrop of recent epidemiological changes, reassessment of national strategies to fight HIV/AIDS was required. In this context, a surge in the incidence of HIV among addicts was specifically mentioned.

Vice Chancellor Prof M. Hameed of the DMU, Prof D. S. Akram, Dr Syed Abdul Mujib, Dr Altaf, Dr Ayesha Mehnaz, Dr Inkisar Ali were among those who attended the presentation. -APP