After the first line of defence fails, AIDS patients find the second line unaffordable, says Ketan Tanna

Shashikant Shetye cannot afford to die. His mother and grandmother depend on his income as coordinator at Safe Sailors’ Club, part of the Humsafar Trust. The 40-year-old AIDS patient also cannot afford the expensive second line of anti-retroviral drugs (ART). While the first line of ART treatment costs Rs 1,200 a month, the second line costs anywhere between Rs 15,000 and Rs 40,000.
“I know that my body is now resistant to the first line of drugs, which I have been taking for some years. I need to take the second line. But they cost the earth,” says Shetye, helplessly. He is losing time.
In the past six months, he has lost 20 kilos, and weighs only 54 now. He has been hospitalised four times with severe diarrhoea. His count of CD4 (a type of white blood cell) has reduced to 111 from 264 over the past three years. A count below 200 is AIDS. “I am running my home on my savings and what I earn now. I don’t know what the future holds for me and I don’t know when I will die,” he says.
Money adds to the helplessness at the testing stage itself. Barring two private clinics in Mumbai, no other institution has the expertise or the equipment to conduct such a test, which costs more than Rs 30,000.
Nearly 52 lakh Indians are infected with HIV and AIDS. The National AIDS Control Organisation (Naco) now intends to provide the first line of drugs to one lakh patients by early 2007. Doctors say this is not good enough. Very soon, a second line of treatment will have to be stocked up. Even for the healthier lot of AIDS patients, as the first line sometimes starts failing in a couple of years. This invariably happens when the patient has either been lax in taking the drugs or was prescribed the wrong dosage.
“This is a serious problem that we face in Maharashtra. I have come across hundreds of patients who have either been given the wrong combination or the wrong dosage of ART drugs by doctors,” says a worried Dr Alka Deshpande, head, department of medicine, J J Hospital.
She sifts through a huge file of prescriptions that show how some doctors have been either careless or had limited knowledge. “There is little or no prescription monitoring. Drug companies have their own agenda in pushing the drugs they manufacture. The combination of these two factors have hit the lives of many patients,” she says, sighing.
In April 2006, 32-year-old Ritesh Batra died in pain. An already tired Batra reached the J J Hospital in 2004 after taking the ART treatment for a while in his home state of Punjab. However, in May 2005, his body started showing resistance to the first line of drugs. His vision slowly blurred and opportunistic infections swooped down on him. Tests were conducted at a reputed clinic in France, and a second line of drugs was started privately. But, by then, he had developed a bad case of diarrhoea and his body could not take it anymore. His wife too was diagnosed with HIV, but she has a CD4 count of over 400 and is not under the ART treatment. Fortunately, their little daughter is not HIV positive. But one wonders what will happen to her later.
Ironically, the government’s AIDS programme that is replete with numbers does not have any hard statistics on what percentage of AIDS patients is resistant to the first line of drugs.
Sunil Jadhav, 31, died in June 2005. Little is known about his family, but he approached J J hospital in June 2004. Before he went to the hospital, he was on the two-drug first line treatment. Unfortunately, since he was not working, he took the required drugs as and when he could afford them. Later, when the government started the free ART programme at J J Hospital, he had a viral load count (the amount of HIV virus in the blood) of 1,79,638 and a CD4 count of 120. He was then given a third tablet as a part of the treatment, in addition to the two that he had been taking.
But within a few months, his body started showing drug resistance. His test was also done in France.
The second line, it seems, is not for the masses. Their bodies are meant to just give up one day. TNN