Thursday, March 08, 2007
Tuesday, March 06, 2007
Adding Salt to the Injury-poser to NACO againj
Dear Dr.Rewari Sir,
Thanks for taking notice of the things.when i cited a case of reduction of d4T dosages ,I cited only after confirming the weight.The reduction was done just because of shoratge anyways.
To add salt to the injury I was informed of death of another patient APS s/o KD.This patient used to come to me from Pasla a village near Jalandhar(80KMS from Amritsar) ever since 2003.His mRNA in March 2003 was 141550,cD4 13,cD8 447 and had CMV retinitis. By October his cD4 went upto 318 and viral load was 1118 with ARV's( d4T+3TC+EFV),february 2004 cd4 was 285 and till mid 2006 he maintained cd4 above 250 and was doing well. then because of distance and economy he went to ART ,center,Jalandhar in later quarter of 2006 when the center came into being.. The people manning that center failed to recognise the clinical and immunological failure in time and the result APS breathed his last on two days before.
I agree you train people well. But sir ,my point of view is that is 12 days training sufficient,are the people employed tested for their competance and aptitude before the patients are exposed to them.
My querry is what is the harm in instructing them to avail services of locally available resources.
With best regards
Dr.Rakesh Bharti
MD,American Academy HIV specialist,
27-D,Sant Avenue,The Mall,
Amritsar
143001
telephone-911832277822;9814044213
email-rakesh.bharti1@gmail.com
Thanks for taking notice of the things.when i cited a case of reduction of d4T dosages ,I cited only after confirming the weight.The reduction was done just because of shoratge anyways.
To add salt to the injury I was informed of death of another patient APS s/o KD.This patient used to come to me from Pasla a village near Jalandhar(80KMS from Amritsar) ever since 2003.His mRNA in March 2003 was 141550,cD4 13,cD8 447 and had CMV retinitis. By October his cD4 went upto 318 and viral load was 1118 with ARV's( d4T+3TC+EFV),february 2004 cd4 was 285 and till mid 2006 he maintained cd4 above 250 and was doing well. then because of distance and economy he went to ART ,center,Jalandhar in later quarter of 2006 when the center came into being.. The people manning that center failed to recognise the clinical and immunological failure in time and the result APS breathed his last on two days before.
I agree you train people well. But sir ,my point of view is that is 12 days training sufficient,are the people employed tested for their competance and aptitude before the patients are exposed to them.
My querry is what is the harm in instructing them to avail services of locally available resources.
With best regards
Dr.Rakesh Bharti
MD,American Academy HIV specialist,
27-D,Sant Avenue,The Mall,
Amritsar
143001
telephone-911832277822;9814044213
email-rakesh.bharti1@gmail.com
Response from Mumbai too
Dear FORUM,Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/6975Dr. Rewari is right that there are many physicians in India whose help can be saught if you face a dilemma in managing your patient on ART. but, rarely doctors take a second opinion. I have a HIV- II patient who went to Hinduja hospital for treatment. He was prescribed a AZT + LMV + EFV combination (CD-4 COUNT- 25 but still no significant symptoms) The patient took all the prscribed medicines for a month. When he was about to start the 2'nd month traement, he fortunately read the company's product monograph leaflet and realised that Efavir has no action against HIV II. He came to me saying that how can an MD physician (who was taking care of Late Pramod Mahajan) has no knowledge about this very basic.This is just one example. I have many a cases of mis- management by our doctor friends. Help is available at al the government set ups where patients who can afford to shell out money should be prescribed medicines and not enroled for free ART. Government, NGOs and individual volunteers ( who may be doctors) must promote this concept of --" correct counseling and diagnosis-- is to undertaken only at recognised centers and qualified or a specially trained physician." This HIV-ii patient is not on ART. After, drug sensitivity test from a recognised lab (as the patent can afford it), a PI based regimen with NRTIs combination would be considered after discussing the strategy of the treatment with the patient. Drug sequencing also might be a very big challange for him.
Dr. Divya Mithel, Jyothis Care Center, Kalambolie
-mail: <d_mithel@yahoo.com> __._,_.___
Dr. Divya Mithel, Jyothis Care Center, Kalambolie
-mail: <d_mithel@yahoo.com> __._,_.___
NACO official Responds to the quality Care at ART's
Dear FORUM,Ref: http://health.groups.yahoo.com/group/AIDS-INDIA/message/6974At the outset I thank Dr Bharti for his feedback. I totally agree with you that provisiong of ART has to be done carefully and scientifically by any Physician, whether is paid or in free roll out. The free roll out is never meant to compromise on quality of care or sensitiveness in treating PLHAs. NACO never starts a ART centre without training of faculty members from Medicine, paeds, gyane and dermatology departments. Alongwith this one medical officer, one counsellor, one satff nurse and one data manager is provided additionally to ART Centre by NACO.The medical officer undergoes a 12 days training before centre starts. All this is done to provide good quality care with a view to avoid drug resistance . The staff is also sensitized on issues of stigma and discrimination. As regards quality of drugs is concerned, only WHO prequalified or GMP companies medicines are procured following an International Competitive Bidding process and all drugs undergo pre supply and random post supply quality checks.No orders have been given to use lower doses of stavudine in case 40 mg has run short. Many a times as patients gain weight and require higher strength, there might be sometimes shortages for which drugs are shifted from other centres. I personally feel that doctors are hesistant to seek 2nd opinion in case they are in some difficult situation and this happens for any disease they are treating.We have to come out of this. ART information is available on some many websites and we have so many experienced persons in country that getting a opinion by email should be no problem.I will definately look into some of cases you have given. Such a feedback is not a crticism but helpful in increasing the levels of care to PLHAs to which all of us at NACO are committed Dr B.B.Rewari MD,FICP,FIACM,FIMSASr.Physician,Dr RML Hospital& National Programme Officer (ART)National AIDS Control Organistion (NACO) New DelhiTel;23325343,23325335(O)FAX : 011-23731746e-mail: <drbbrewari@yahoo.com>
Comments by Dr.Vineeta Gupta
Dr. Bharti,
You are so right and thanks for bringing this up. The quality of the programs is so importnat to the quantity of the programs for the success of teh program.
We did exchange a few emails a few months back:). Please keepme in the loop and we should certainly discuss how can we get this point of view more visibility and importance while shaping any international response to HIV/AIDS in India.
Best,
Vineeta
- Show quoted text -"Dr.Rakesh Bharti" <AIDS-INDIA@yahoogroups.com> wrote:
- Show quoted text -
Quality of care and treatment in Antiretroviral Treatment centers – a case studyIt is wonderful to roll out free treatment to HIV patients by NACO. Three cheers for the same. The cheers may however become louder if NACO also takes care on the quality of treatment handed over to people living with HIV in these centers. I was hesitant to write this but the death of few of my patients has forced me to present the following cases to the national audience. The hope is that NACO will soon take remedial measures, sooner than soon so that many lives can be saved.Case 1: M.S s/o B.S, 35 years male came to me in June 2006 with Herpes Zoster, HIV and HCV positivity and Cd4 90. He was offered treatment for HZ and also advised ARV as the viral load of HCV was not significant and LFT were within the normal range. He could not afford ARV's as in his joint family already one brother was taking them and economy was a constraint. On world AIDS day December 1, 2006, after reading the news about free ARV's he approached me again and I referred him to the local ART Center in Amritsar. He was put on AZT+3TC+NVP combination by the center. Unfortunately he developed rash due to nevirapine, but was continued with the same along with symptomatic treatment of the rash. The rash kept on increasing and in the mean time he also started showing signs of jaundice. His LFT`s were deranged. The patient was admitted in the Medicine department of Medical College where the ART center is located. This was in first/second week of February,2007.The treatment patient got in this tertiary care center was so derogatory and discriminatory that the patient got himself referred to PGIMER,Chandigarh(which, however was done only after the relations agreed to sign a paper stating that they were given good treatment).The patient came back to me .He was diagnosed to have drug induced hepatitis (Nevirapine appeared the culprit) and he expired on 23.2.2007 despite our best efforts for five days in a private hospital. MS died of a cause which could have been averted by timely action. The only consolation to the family was that the last few days of his life were neither derogatory nor discriminatory.Case 2: K.S s/o B.S, 43 Male was on ARV (d4T+3TC+NVP) ever since 13.10.2002 from me. He presented with Psoriasis and HIV with cd4 38. Till the time of his referral to ART center, he was at least doing good clinically and was back to work, earning money for the family. Coincidentally or otherwise ( I suspect the quality of ARV's supplied at these centers) the patient started showing signs of clinical failure after he started getting free treatment from ART, Amritsar. His cd4 according to that center was 28 in January 2007 and 25 in February. He started having diarrhea and loss of weight but no action or second opinion from experienced doctors (like me, who is into practice and still has to say no, rather has always asked the staff there to seek help whenever required 24/7 for all patients specially those who have been referred by me only) of the town was taken. Result, he was referred to PGIMER Chandigarh in the last week of February, which he refused and breathed his last on 2nd March, 2007 at his home.Case 3: L d/o PLK, 26 Female was a HIV widow ever since May 2001 and was under care of AIIMS, Delhi before coming under my care in June 2004. She was doing well with AZT+3TC+EFV combination clinically, immunological and virologically but not economically. Somehow she got married again in August 2006. Because of free availability of drugs and economic constraints I referred her to The ART Center, Amritsar. She returned in tears with pledge of never going back again to that center. Reason – she was put to an awkward situation of questioning both at ART center as well as VCTC attached to same Medical College (as she was wearing the bridal make up). Do we need provide free treatment alone or it is required to be sensitive too.Case 4; GK s/o BL,27 Male was on d4T+3TC+EFV ever since 22.9.2003.His Cd4 in the begging were 137 but over the period of time they were above 250 always and he was doing good clinically. In 2006 he developed Koch's, and was put on ATT along with. During this period he was also referred by me for free ARV's and ATT to ART Center, Amritsar. On completion of his ATT, his ARV combination was changed from EFV to NVP despite the fact that he was not having any side effects of Efavirenz and also was doing good. On question the MO of the center told me that she has such instructions.She (The MO of the Center) however failed to show me the evidence of such guidelines. I also switched from EFV to NVP to my private patients but that was always for the reasons of side effects /or economy after completion of ATT. When meds are free I do not find any reason of switching ARV without scientific reason. This is truer in the era of emerging resistances to ARV's.Case5: AS s/o MS is on treatment since 13.11.2002 d4T+3TC+NVP. He was referred to ART Center, Amritsar for reasons of economy again. His dosage of stauvudine was reduced to 30 mg from 40 (he weighs 90 kg) just for the reason of short supply. When contacted the MO said how does it matter for a month or two. My question is then why give 40 mg at all to anyone. Maintenance of continuous supply is a must. Result is that for last two months the patient is taking Triomune 40 from market.Case6: HS s/o PS, 58 years male went to ART on his own with PHN and h/o HIV positivity for one year. His cd4 was 600 plus from a private lab. He was prescribed Majetol for PHN .He developed exfoliative dermatitis due to the drug –Majetol. He was admitted in the Medicine department of the Medical College where ART is located. The treatment matted out to him again like another case cited above was discriminatory to the extent that he preferred to come to me, a private practitioner even at the cost of money (it is another matter that I hardly earn from my practice on HIV patients and only thrive on my dermatology practice) Don't you think that free treatment with dignity is the order of the day rather than just free treatment.Point wise the lessons from various cases respectively are1. Ensure training people about management of drug reactions.2. Persons manning ART centers should be encouraged to take help from local experienced physicians – (may be in whatever set up, e.g. persons like me who am an American Academy HIV Specialist, and thus encourage private public coordination).3. Counseling comes from heart and not by training –the personnel should be more humane and there should be checks, such examples can be a set back to the programe.4. The switching of ARV is a serious matter and should be taken seriously; for sure it should not be done just for the heck of it.5. The dosages should be strictly adhered to and continuous supply of drugs be ensured always. In case some break occurs, please tell the truth and ask patient to purchase right combination in right doses, till supplies. Do not play with the lives of patients. Drug Resistance is a serious matter.6. Time has come to sensitize all the medical fraternity, that HIV patients should be provided quality care with a human heart and approach. Practice what we preach. The disease does not spread by casual contact-remember always.To summarize the whole issue I want to conclude that, the presentation of these cases are not meant to belittle anyone or to complaint against any one. The sole purpose is to awaken people who matter. This may induce some heart in giving HAART. I think in treating diseases like HIV and Leprosy (for which also I work) what is required more than the brain and training is the sensitivities and a humane approach.Dr.Rakesh Bharti, MD, AAHIVS,BDC Research Center,27-D, Sant Avenue, The Mall,Amritsar 143001Telephone 9814044213email-rakesh.bharti1@gmail.com__._,_.___
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__________________________________________Speak your world with an accent, your own experience!.An eFORUM for communication and information on HIV& AIDSrelated issues in India. The views are of the authors.Please feel free to copy the messages. An acknowledgement[Source: AIDS-INDIA eFORUM] would be appreciated.To Post a message:E-mail to: aids-india@yahoogroups.com We comply with the 'HONcode' standard for trustworthy health information and global internet governance norms.For further assistance please contact the forum moderatorDr. Joe Thomas by e-mail; joe_thomas123(at)yahoo.com.auor by Skype: joethomas123__________________________________________
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Vineeta Gupta
MD, JD, LL.M
Director, Stop HIV/AIDS in India Initiative
Phone 202-789-0432 Ext 207
www.shaii.org
You are so right and thanks for bringing this up. The quality of the programs is so importnat to the quantity of the programs for the success of teh program.
We did exchange a few emails a few months back:). Please keepme in the loop and we should certainly discuss how can we get this point of view more visibility and importance while shaping any international response to HIV/AIDS in India.
Best,
Vineeta
- Show quoted text -"Dr.Rakesh Bharti" <AIDS-INDIA@yahoogroups.com> wrote:
- Show quoted text -
Quality of care and treatment in Antiretroviral Treatment centers – a case studyIt is wonderful to roll out free treatment to HIV patients by NACO. Three cheers for the same. The cheers may however become louder if NACO also takes care on the quality of treatment handed over to people living with HIV in these centers. I was hesitant to write this but the death of few of my patients has forced me to present the following cases to the national audience. The hope is that NACO will soon take remedial measures, sooner than soon so that many lives can be saved.Case 1: M.S s/o B.S, 35 years male came to me in June 2006 with Herpes Zoster, HIV and HCV positivity and Cd4 90. He was offered treatment for HZ and also advised ARV as the viral load of HCV was not significant and LFT were within the normal range. He could not afford ARV's as in his joint family already one brother was taking them and economy was a constraint. On world AIDS day December 1, 2006, after reading the news about free ARV's he approached me again and I referred him to the local ART Center in Amritsar. He was put on AZT+3TC+NVP combination by the center. Unfortunately he developed rash due to nevirapine, but was continued with the same along with symptomatic treatment of the rash. The rash kept on increasing and in the mean time he also started showing signs of jaundice. His LFT`s were deranged. The patient was admitted in the Medicine department of Medical College where the ART center is located. This was in first/second week of February,2007.The treatment patient got in this tertiary care center was so derogatory and discriminatory that the patient got himself referred to PGIMER,Chandigarh(which, however was done only after the relations agreed to sign a paper stating that they were given good treatment).The patient came back to me .He was diagnosed to have drug induced hepatitis (Nevirapine appeared the culprit) and he expired on 23.2.2007 despite our best efforts for five days in a private hospital. MS died of a cause which could have been averted by timely action. The only consolation to the family was that the last few days of his life were neither derogatory nor discriminatory.Case 2: K.S s/o B.S, 43 Male was on ARV (d4T+3TC+NVP) ever since 13.10.2002 from me. He presented with Psoriasis and HIV with cd4 38. Till the time of his referral to ART center, he was at least doing good clinically and was back to work, earning money for the family. Coincidentally or otherwise ( I suspect the quality of ARV's supplied at these centers) the patient started showing signs of clinical failure after he started getting free treatment from ART, Amritsar. His cd4 according to that center was 28 in January 2007 and 25 in February. He started having diarrhea and loss of weight but no action or second opinion from experienced doctors (like me, who is into practice and still has to say no, rather has always asked the staff there to seek help whenever required 24/7 for all patients specially those who have been referred by me only) of the town was taken. Result, he was referred to PGIMER Chandigarh in the last week of February, which he refused and breathed his last on 2nd March, 2007 at his home.Case 3: L d/o PLK, 26 Female was a HIV widow ever since May 2001 and was under care of AIIMS, Delhi before coming under my care in June 2004. She was doing well with AZT+3TC+EFV combination clinically, immunological and virologically but not economically. Somehow she got married again in August 2006. Because of free availability of drugs and economic constraints I referred her to The ART Center, Amritsar. She returned in tears with pledge of never going back again to that center. Reason – she was put to an awkward situation of questioning both at ART center as well as VCTC attached to same Medical College (as she was wearing the bridal make up). Do we need provide free treatment alone or it is required to be sensitive too.Case 4; GK s/o BL,27 Male was on d4T+3TC+EFV ever since 22.9.2003.His Cd4 in the begging were 137 but over the period of time they were above 250 always and he was doing good clinically. In 2006 he developed Koch's, and was put on ATT along with. During this period he was also referred by me for free ARV's and ATT to ART Center, Amritsar. On completion of his ATT, his ARV combination was changed from EFV to NVP despite the fact that he was not having any side effects of Efavirenz and also was doing good. On question the MO of the center told me that she has such instructions.She (The MO of the Center) however failed to show me the evidence of such guidelines. I also switched from EFV to NVP to my private patients but that was always for the reasons of side effects /or economy after completion of ATT. When meds are free I do not find any reason of switching ARV without scientific reason. This is truer in the era of emerging resistances to ARV's.Case5: AS s/o MS is on treatment since 13.11.2002 d4T+3TC+NVP. He was referred to ART Center, Amritsar for reasons of economy again. His dosage of stauvudine was reduced to 30 mg from 40 (he weighs 90 kg) just for the reason of short supply. When contacted the MO said how does it matter for a month or two. My question is then why give 40 mg at all to anyone. Maintenance of continuous supply is a must. Result is that for last two months the patient is taking Triomune 40 from market.Case6: HS s/o PS, 58 years male went to ART on his own with PHN and h/o HIV positivity for one year. His cd4 was 600 plus from a private lab. He was prescribed Majetol for PHN .He developed exfoliative dermatitis due to the drug –Majetol. He was admitted in the Medicine department of the Medical College where ART is located. The treatment matted out to him again like another case cited above was discriminatory to the extent that he preferred to come to me, a private practitioner even at the cost of money (it is another matter that I hardly earn from my practice on HIV patients and only thrive on my dermatology practice) Don't you think that free treatment with dignity is the order of the day rather than just free treatment.Point wise the lessons from various cases respectively are1. Ensure training people about management of drug reactions.2. Persons manning ART centers should be encouraged to take help from local experienced physicians – (may be in whatever set up, e.g. persons like me who am an American Academy HIV Specialist, and thus encourage private public coordination).3. Counseling comes from heart and not by training –the personnel should be more humane and there should be checks, such examples can be a set back to the programe.4. The switching of ARV is a serious matter and should be taken seriously; for sure it should not be done just for the heck of it.5. The dosages should be strictly adhered to and continuous supply of drugs be ensured always. In case some break occurs, please tell the truth and ask patient to purchase right combination in right doses, till supplies. Do not play with the lives of patients. Drug Resistance is a serious matter.6. Time has come to sensitize all the medical fraternity, that HIV patients should be provided quality care with a human heart and approach. Practice what we preach. The disease does not spread by casual contact-remember always.To summarize the whole issue I want to conclude that, the presentation of these cases are not meant to belittle anyone or to complaint against any one. The sole purpose is to awaken people who matter. This may induce some heart in giving HAART. I think in treating diseases like HIV and Leprosy (for which also I work) what is required more than the brain and training is the sensitivities and a humane approach.Dr.Rakesh Bharti, MD, AAHIVS,BDC Research Center,27-D, Sant Avenue, The Mall,Amritsar 143001Telephone 9814044213email-rakesh.bharti1@gmail.com__._,_.___
Messages in this topic (1) Reply (via web post) Start a new topic
Messages
__________________________________________Speak your world with an accent, your own experience!.An eFORUM for communication and information on HIV& AIDSrelated issues in India. The views are of the authors.Please feel free to copy the messages. An acknowledgement[Source: AIDS-INDIA eFORUM] would be appreciated.To Post a message:E-mail to: aids-india@yahoogroups.com We comply with the 'HONcode' standard for trustworthy health information and global internet governance norms.For further assistance please contact the forum moderatorDr. Joe Thomas by e-mail; joe_thomas123(at)yahoo.com.auor by Skype: joethomas123__________________________________________
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. __,_._,___
Vineeta Gupta
MD, JD, LL.M
Director, Stop HIV/AIDS in India Initiative
Phone 202-789-0432 Ext 207
www.shaii.org
Quality of care and treatment in ART Centers-a case Study
It is wonderful to roll out free treatment to HIV patients by NACO. Three cheers for the same. The cheers may however become louder if NACO also takes care on the quality of treatment handed over to people living with HIV in these centers. I was hesitant to write this but the death of few of my patients has forced me to present the following cases to the national audience. The hope is that NACO will soon take remedial measures, sooner than soon so that many lives can be saved.Case 1: M.S s/o B.S, 35 years male came to me in June 2006 with Herpes Zoster, HIV and HCV positivity and Cd4 90. He was offered treatment for HZ and also advised ARV as the viral load of HCV was not significant and LFT were within the normal range. He could not afford ARV's as in his joint family already one brother was taking them and economy was a constraint. On world AIDS day December 1, 2006, after reading the news about free ARV's he approached me again and I referred him to the local ART Center in Amritsar. He was put on AZT+3TC+NVP combination by the center. Unfortunately he developed rash due to nevirapine, but was continued with the same along with symptomatic treatment of the rash. The rash kept on increasing and in the mean time he also started showing signs of jaundice. His LFT`s were deranged. The patient was admitted in the Medicine department of Medical College where the ART center is located. This was in first/second week of February,2007.The treatment patient got in this tertiary care center was so derogatory and discriminatory that the patient got himself referred to PGIMER,Chandigarh(which, however was done only after the relations agreed to sign a paper stating that they were given good treatment).The patient came back to me .He was diagnosed to have drug induced hepatitis (Nevirapine appeared the culprit) and he expired on 23.2.2007 despite our best efforts for five days in a private hospital. MS died of a cause which could have been averted by timely action. The only consolation to the family was that the last few days of his life were neither derogatory nor discriminatory.Case 2: K.S s/o B.S, 43 Male was on ARV (d4T+3TC+NVP) ever since 13.10.2002 from me. He presented with Psoriasis and HIV with cd4 38. Till the time of his referral to ART center, he was at least doing good clinically and was back to work, earning money for the family. Coincidentally or otherwise ( I suspect the quality of ARV's supplied at these centers) the patient started showing signs of clinical failure after he started getting free treatment from ART, Amritsar. His cd4 according to that center was 28 in January 2007 and 25 in February. He started having diarrhea and loss of weight but no action or second opinion from experienced doctors (like me, who is into practice and still has to say no, rather has always asked the staff there to seek help whenever required 24/7 for all patients specially those who have been referred by me only) of the town was taken. Result, he was referred to PGIMER Chandigarh in the last week of February, which he refused and breathed his last on 2nd March, 2007 at his home.Case 3: L d/o PLK, 26 Female was a HIV widow ever since May 2001 and was under care of AIIMS, Delhi before coming under my care in June 2004. She was doing well with AZT+3TC+EFV combination clinically, immunological and virologically but not economically. Somehow she got married again in August 2006. Because of free availability of drugs and economic constraints I referred her to The ART Center, Amritsar. She returned in tears with pledge of never going back again to that center. Reason – she was put to an awkward situation of questioning both at ART center as well as VCTC attached to same Medical College (as she was wearing the bridal make up). Do we need provide free treatment alone or it is required to be sensitive too.Case 4; GK s/o BL,27 Male was on d4T+3TC+EFV ever since 22.9.2003.His Cd4 in the begging were 137 but over the period of time they were above 250 always and he was doing good clinically. In 2006 he developed Koch's, and was put on ATT along with. During this period he was also referred by me for free ARV's and ATT to ART Center, Amritsar. On completion of his ATT, his ARV combination was changed from EFV to NVP despite the fact that he was not having any side effects of Efavirenz and also was doing good. On question the MO of the center told me that she has such instructions.She (The MO of the Center) however failed to show me the evidence of such guidelines. I also switched from EFV to NVP to my private patients but that was always for the reasons of side effects /or economy after completion of ATT. When meds are free I do not find any reason of switching ARV without scientific reason. This is truer in the era of emerging resistances to ARV's.Case5: AS s/o MS is on treatment since 13.11.2002 d4T+3TC+NVP. He was referred to ART Center, Amritsar for reasons of economy again. His dosage of stauvudine was reduced to 30 mg from 40 (he weighs 90 kg) just for the reason of short supply. When contacted the MO said how does it matter for a month or two. My question is then why give 40 mg at all to anyone. Maintenance of continuous supply is a must. Result is that for last two months the patient is taking Triomune 40 from market.Case6: HS s/o PS, 58 years male went to ART on his own with PHN and h/o HIV positivity for one year. His cd4 was 600 plus from a private lab. He was prescribed Majetol for PHN .He developed exfoliative dermatitis due to the drug –Majetol. He was admitted in the Medicine department of the Medical College where ART is located. The treatment matted out to him again like another case cited above was discriminatory to the extent that he preferred to come to me, a private practitioner even at the cost of money (it is another matter that I hardly earn from my practice on HIV patients and only thrive on my dermatology practice) Don't you think that free treatment with dignity is the order of the day rather than just free treatment.Point wise the lessons from various cases respectively are1. Ensure training people about management of drug reactions.2. Persons manning ART centers should be encouraged to take help from local experienced physicians – (may be in whatever set up, e.g. persons like me who am an American Academy HIV Specialist, and thus encourage private public coordination).3. Counseling comes from heart and not by training –the personnel should be more humane and there should be checks, such examples can be a set back to the programe.4. The switching of ARV is a serious matter and should be taken seriously; for sure it should not be done just for the heck of it.5. The dosages should be strictly adhered to and continuous supply of drugs be ensured always. In case some break occurs, please tell the truth and ask patient to purchase right combination in right doses, till supplies. Do not play with the lives of patients. Drug Resistance is a serious matter.6. Time has come to sensitize all the medical fraternity, that HIV patients should be provided quality care with a human heart and approach. Practice what we preach. The disease does not spread by casual contact-remember always.To summarize the whole issue I want to conclude that, the presentation of these cases are not meant to belittle anyone or to complaint against any one. The sole purpose is to awaken people who matter. This may induce some heart in giving HAART. I think in treating diseases like HIV and Leprosy (for which also I work) what is required more than the brain and training is the sensitivities and a humane approach.Dr.Rakesh Bharti, MD, AAHIVS,BDC Research Center,27-D, Sant Avenue, The Mall,Amritsar 143001Telephone 9814044213email-rakesh.bharti1@gmail.com
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