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Experts call for multipronged strategy to address drug resistance affecting TB & HIV treatment in country

Laxmi Yadav, Mumbai
Monday, October 18, 2021, 08:00 Hrs  [IST]

Expressing concern over drug resistance impeding responses to both tuberculosis (TB) and human immunodeficiency virus (HIV), AIDS Society of India (ASI) along with prominent experts of TB and HIV from across the country have called for multipronged approach to manage all forms of drug resistance threatening responses to both the diseases.

These include early and rapid diagnosis with genotypic tests, prompt treatment with appropriate regimens based on drug-susceptibility testing, preference for shorter regimens fortified with newer drugs, a patient-centric approach, and stronger infection-control measures.

TB and HIV care is among those health priorities that slipped off the radar since the beginning of the Covid pandemic. A recent study estimated an additional 20 per cent rise in TB deaths and 10 per cent rise in HIV deaths in five years in the country due to Covid pandemic. It is high time to not lose the major advances India has made in fighting both TB and HIV and accelerate progress towards ending AIDS and TB both as committed by the government of India.

TB and HIV drug resistance threatens the effective prevention and treatment. When drug resistance develops, the TB bacteria and AIDS virus change so that they no longer respond to medicines, making infections harder to treat, more expensive to treat, and increasing the risk of disease spread, severe illness and death.

A high level meeting was recently convened to seek commitments for stronger private public partnerships so that unitedly the country can combat drug resistance which is adversely impacting both TB and HIV responses in the country.

Dr Sudarshan Mandal, head of Indian Government's National TB Elimination Programme, and Dr Ishwar Gilada, president of AIDS Society of India (ASI) co-chaired the high level ASI Advisory Board meeting on managing multidrug-resistant TB and HIV in the country.

Several ASI leaders and prominent experts of TB and HIV from across the country have resolved to work together with the government in caring for multidrug-resistant TB (MDR-TB) in order to support the Prime Minister's resolve to end TB by 2025, in reducing stigma associated with especially MDR-TB, and training medical caregivers in appropriate care and on newer treatment guidelines and educating the masses on TB, MDR-TB, MDR-HIV and its prevention and control.

Dr Ishwar Gilada, president, ASI said “TB is commonest and deadliest of the opportunistic infections for people living with HIV even today - this is not acceptable as we know how to prevent infection spread, reduce risk of latent TB converting into active disease, and know how to accurately diagnose and treat TB. Preventing TB especially among those at high risk is an imperative for public health. Every case of active TB disease (as well as primary drug resistant TB) comes from latent TB pool in our population. But only 45 per cent of newly diagnosed people living with HIV were put on preventive TB therapy in 2019 in India. We must multiply our efforts to break the chain of TB transmission as well as reduce risk for those with latent TB to progress to active disease as far as possible if we are to end TB by 2025.”

Dr Vikas S Oswal, chest consultant, National TB Elimination Programme trainer and chairperson of DPS Shatabdi Municipal Hospital, Mumbai, emphasized on the need of timely and rational use of latest more effective, less toxic and shorter duration treatment therapies for multidrug-resistant TB, which also works with comparable efficacy for people co-infected with HIV.

Dr Oswal is also leading the site for India's first site where rollout of the latest treatment for drug-resistant TB has begun yesterday, results of which will help guide our national programme policy and further actions.

As per latest WHO Global TB Report, in India, almost half a million (4.45 lakhs) TB deaths occurred in 2019, which includes 9,500 deaths among people with HIV.

About 71,000 people living with HIV fell ill with TB in the country in 2019, out of which 44517 people were notified and were on lifesaving antiretroviral treatment. In 2019, about 1.24 lakh people in India were estimated to have drug-resistant TB, out of which only 56,569 were put on possible treatment, said Dr Ameet Dravid, HIV Medicine and infectious diseases expert from Ruby Hall Clinic and Poona Hospital, Pune.

 

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