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Why are people living with HIV still dying of AIDS in India?

It’s unacceptable that people living with HIV are still dying because the tests and life-saving treatment for life-threatening infections are not available
At the beginning of this century, AIDS-related illnesses were common among patients unaware of their HIV status of a lack of HIV testing and antiretroviral treatment availability. Over 36 million people have died from AIDS-related illnesses since the start of the epidemic.

Governments like India have made considerable progress in providing access to HIV testing and antiretroviral therapy (ART) (a cocktail of antivirals drugs that suppress the virus) to people living with HIV.
Yet, we know that India lost nearly sixty thousand people living with HIV in 2019, and there is concern that these numbers could be higher as the pandemic undermines progress with lockdowns and stretched healthcare systems.

AIDS remains a crisis, and COVID-19 is making it worse, says Winnie Byanyima of United Nations Programme on HIV and AIDS (UNAIDS).
Even today, in the era of antiretroviral therapy, we are losing people living with HIV to AIDS-related illnesses (such as TB, pneumocystis pneumonia in the lungs, cryptococcal meningitis, a painful fungal infection of the brain, CMV and toxoplasmosis). One-third of people living with HIV still present in ART with CD4 cell counts of less than 200 cells/mm. We have also seen PLHIVs on ART develop resistance to their regimen and become vulnerable to the above life-threatening bacterial and fungal infections.

We are concerned that PLHIV in India currently do not have access to the complete package of screening tests, prophylaxis and treatments needed to reduce deaths due to Advanced HIV Disease.

As India recovers from the pandemic, World AIDS Day provides an opportunity to assess the response to the continued mortality due to AIDS.

We demand that National AIDS Control Organization (NACO) and Sikkim State AIDS Control Society (SSACS):

Focus on vulnerable PLHIVs who have low CD4 and critically unwell AHD patients in the ART programme;
Screening for TB and Cryptococcal Meningitis: ART centres do not have the tools to screen for life-threatening bacterial and fungal infections. Ensure that screening with TB-LAM and CrAg Cryptococcal Antigen Lateral Flow Test is carried out systematically at all ART centres in people living with HIV with CD4 below 200;
Registration of TB- LAM – NACO should support the registration of TB-LAM test in the country by the CDSCO and request the DCGI to waive local studies and validation requirement as the WHO already recommends use of the first generation TB lipoarabinomannan (TB LAM) test for diagnosing TB in people with HIV; NACO and SACS must ensure referral for Hospital level facilities to provide critical care to PLHIVs with AHD and that they are not turned away due to stigma and discrimination;
CD4 testing – Ensure that all PLHIVs on ART can access CD4 testing and not just at the time of ART initiation;
Viral Load – Ensure that all PLHIVs on ART are able to access viral load testing as recommended by the WHO. Many states are reporting that viral load monitoring has been disrupted or delayed due to COVID-19 and the end of contract of viral load services with the agency Metropolis;
Prevention of AIDS-related illnesses – Prioritise and strengthen preventive therapy for TB (TPT), Fluconazole pre-emptive therapy for cryptococcal meningitis and Co-trimoxazole Preventive Therapy (CPT) as it protects PLHIVs with stage 3 or 4 diseases or CD4 <350 cells/mm from Pneumocystis pneumonia (PCP), toxoplasmosis and other bacterial infections;
Access to drugs for AHD – Monitor the availability of essential drugs for AHD (fluconazole, conventional amphotericin B or Liposomal Amphotericin B, flucytosine, valganciclovir and antibiotics) at the state level. Some medicines may need to be centrally procured by NACO and made available for AHD;
Ensure pediatric formulations (LPV/r, ABC/3TC, DTG) are not merely exported but available to the ART programme;
Ensure NACO’s centres of excellence have clinical expertise and appropriate laboratory capacity in the management of critically unwell AHD patients;
Funding – Incorporate AHD into Global Fund requests and U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Country Operational Plans

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