HEPATITIS C TREATMENT ALONE AND WITH HEPATITIS B OR WITH HIV INFECTION WITH NEW RECNTLY ADDED DASS DRUGS
Posted by on Tuesday, 24th December 2013
HEPATITIS C TREATMENT ALONE AND WITH HEPATITIS B OR WITH HIV INFECTION;
DR.D.R.NAKIPURIA ,SENIOR GASTRO INTEST SPECIALIST & HIV/AIDS CONSULTANT
drnakipuria@gmail.com, 09434143550,09832025033
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Treatment for hepatitis C virus (HCV) infection is indicated even in acute stage as result is ver good and resonse comes early and SVR IS ACHIEVED,ALTHOUGH 15-20 % of ACUTE HCV themselves clear witout treatment but 80% become chronic mostly spead by blood contamination or needle stick injury (1-10%) very less by sexual exposure,mother to child only 4%,huggung kissing ,eating together almost never transmit it,direct with blood in veins,or breached skin or even contact mith mucosa spreads it but chance by sweat,saliva,tear is less but blood,peritoeneal, ascitic,csf, vaginal,semen,urine,stool is infective.treatment for HCV has advanced dramatically in the past few years as direct-acting antiviral agents, or DAAs or drugs kike SOBOSFUVIR,SIMEPREVIR,SOVAPREVIR,DAROPREVIR,GS5885,DACLATASVIR, have improved cure rates and shortened treatment duration WITH ADDED TELAPREVIR AND BOCEPREVIR with standarad Peglyated Interferon and Ribavarin.
Mostly patient know about infection in late stage or chrnic stage when patient notice fatigue,weakness,malaise,nausea,vomiting,fever,or jaundice where we get either by ELSA ENNZYME BASED ANTIBODIES AAGINST HCV IS FOUND which is 95% correct but comes after 6 months some time so acute case is diagnosed late and reconfirmed by Blot Testing of HCV ANTIBODIES ALSO CALLED RIBA,once HCV RNA BY PCR IS DETECTED THEN CONFIRM DIAGNOSIS MADE .The main measure of hepatitis C treatment success is virologic response, or reduction of HCV RNA. Viral load is typically measured after four weeks on treatment (rapid virologic response, or RVR), after 12 weeks (early virologic response, or EVR), at the end of treatment, and after finishing treatment.Beside raised Liver enzymes,altered level of Blodd clottings due to liver disease or features of cirrhosis and ascites with oesophageal varices usually comes late and even jaundice some times comes very late till then cirrhotic changes in LIVER confirmed by Biopsy or mostly by FIBOSCAN or ELSATOGRAPHY is done now a days,biopsy also excludes malignancy and associted advancing inflammation as seen diminished after good therapy responding to treatment .
Sustained virologic response (SVR), or continued undetectable HCV viral load 24 weeks after completing treatment, is traditionally considered a cure. The FDA recently said SVR at 12 weeks post-treatment can also be considered a cure. Sustained response can halt liver disease progression and lowers the risk of developing cirrhosis and liver cancer.Usually 6 genotypes of HCV is known where no 1 is further divided in a,b,c,etc,Type 1 and 4 are late responder and 2,3 good responder,again genetic analysis of "cc is better responding than""tt" or "ct" type.
Not everyone with hepatitis C needs treatment, but it is recommended for people with at least moderate liver damage, usually determined by a liver biopsy. Treatment during acute infection (the first six months after infection) has a very high success rate, but most people do not realize they are infected this soon. Overall, about 25% of people clear HCV spontaneously without treatment, but the proportion is lower among people with HIV.
The previous standard of care for chronic hepatitis C was pegylated interferon alfa-2a (Pegasys) or alfa-2B (PegIntron) injected once weekly plus a weight-adjusted oral dose of ribavirin. Treatment duration is 48 weeks for people with difficult-to-treat HCV genotypes 1 or 4 and 24 weeks for those with genotypes 2 or 3. The overall SVR rate for HCV mono-infected people is about 75% for genotypes 2 or 3, but less than 50% for genotype 1. For the most difficult-to-treat groups of patients, response rates can be as low as 5%.
Several factors influence how well interferon-based therapy works. In addition to HCV genotype, high pre-treatment HCV viral load, advanced liver fibrosis or cirrhosis, insulin resistance, and HIV co-infection are associated with poorer response. People trying treatment again after previous non-response do not do as well as those being treated for the first time. People of African descent generally do not respond as well as white patients.
In 2009, researchers discovered that the latter two factors are largely attributable to variations in the IL28B gene. People with the favorable "CC" gene pattern respond best to interferon, people with the "TT" pattern have the lowest response rates, and people with the "CT" pattern are in between.
Pegylated interferon causes notorious side effects, including flu-like symptoms (fever, chills, fatigue, muscle aches), depression, and low white blood cell count. Ribavirin can cause anemia due to red blood cell destruction. These side effects may be severe enough that people avoid going on treatment, stop treatment prematurely, or lower their drug doses.
"Overall, about 25% of people clear HCV spontaneously without treatment, but the proportion is lower among people with HIV."
In 2011, the FDA approved the first two DAAs for genotype 1 chronic hepatitis C, the protease inhibitors Incivek (telaprevir, developed by Vertex) and Victrelis (boceprevir, developed by Merck). In pivotal clinical trials, adding one of these drugs to pegylated interferon/ribavirin raised overall treatment response rates significantly, both for HIV-negative and HIV-positive patients.
Both drugs are taken three times daily with pegylated interferon/ribavirin (Incivek for 12 weeks, Victrelis for 28 or 36 weeks), followed by continued treatment with pegylated interferon/ribavirin alone. Treatment-naïve people with good early viral suppression can stop treatment sooner (at 24 or 28 weeks), while others continue treatment through week 48.
In Phase 3 clinical trials of HIV-negative people, Incivek SVR rates were 79% for previously untreated people, 86% for prior relapsers, and 32% for prior null responders (those who previously had little or no decrease in HCV viral load). Victrelis SVR rates were 90% for previously untreated people and 66% for prior relapsers and partial non-responders (null responders were excluded).
So-called difficult-to-treat patient groups do not respond as well to hepatitis C therapy but may have a more urgent need for treatment. People with liver cirrhosis can be successfully treated with triple therapy including Incivek or Victrelis, but they have a higher frequency of side effects; studies of liver transplant recipients are underway. HIV/HCV co-infected people using Incivek or Victrelis can achieve response rates close to those of HCV mono-infected people with similar side effects. However, due to drug-drug interactions, these DAAs should not be combined with certain antiretrovirals.
Not surprisingly, adding another drug to the mix can increase adverse events. The most notable side effect of Incivek is skin rash, while Victrelis can cause anemia.
Most cirrhotic liver goes for LIVER TRANSPLANT but usually relapse of HCV occurs after 03-05 yrs but chances of tumor is less so it is practised very much.
Ptient with HBV ARE TREATED WITH HEPATITIS B DRUGS USUSALLY RIBAVARIN IS ADDED AS IT HELPS BOTH OR TENOFOVIR ,EMTRICITABINE AND LAMUVIDINE IS ALSO TRIED,PEGLYATED INTERFERON 21 OR 2B IS ALSO USEFUL,both are treated at a time.
With HIV if cd4 count less than 200 then first HIV is treated and after improvemnet treatment for HCV taken but in presence of HBV or HCV HIV TREATMENT is started soon irrespective of CD4 count ,same way along with HIV,HCV TREATMENT STARTED DASS DRUGS ARE ADDED WITH INTERFERON AND RIBAVARIN WITH HIV MEDICINES SOME DRUGS LIKE PROTESE INHIBITORS AND NUCLOSIDE OR NUCLEOTIDE ANALOGUE INTERACT WE AVOID IT,NEVIRAPINE,DDS IS AVOIDED .
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GAY LESBIAN TRANSGENDER BISEXUALS,HIZRAS(LGBT) -DISCRIMINATION IS CRIME,MSM IS DISEASE,RECOGNISE THEM TO CURB HIV
Posted by on Monday, 23rd December 2013
SCRAPPING OF 377 IPC OR DECRAMINALISATION AND LOVE FOR GAY,LESBIAN, HINJARAS,TRANSGENDERS AND BISEXUALS IS MUST AS MORE WE SUPRESS THESE MAN/WOMAN FOR THEIR NO FAULT AS NO ONE CAN BE PUNISHED FOR ATTITUDE ,BEHAVIOUR ANS STYLE OF LIVING AS ONCE FUNDAMENTAL RIGHT CANNOT BE PUNISHED FOR ANY ACTIVITY HE/SHE PERFORMS IN BED ROOM WITHOUT ANY PROVOCATION IN SOCIETY OR VULGAR BEHAVIOUR AS MAJORITY DOESNOT PRACTICE HOMOSEXUALITY SO LGBT CANNOT OR SHOULD NOT BE PUNISHED.
REVIEW PETITION AGAINST SUPREME COURT TO DECRAMINALISE AND RESPECT,LOVE AND RECOGNITION TO LGBRT IS VERY MUCH NEEDED TO CURB HI/AIDS AND OTHERSEXUAL TRANSMITTED DISEASES AS IT IS FACT MEN TO MEN SEX MAY LEAD TO HIGH HIV/AIDS BUT IT IS BECAUSE OF UNSAFE SEX OR UNPROTECTED SEX WHICH IS A WRONG PRACTICE WHICH IS ALSO SEN IN MANY HETROSEXUALS,SO DISEASE IS A DISEASE FOR A DISEASE A GROUP CAN BE STIGMATISED,DISCRIMINATED OR CRIMINALISED .
PROF.DRRAM ,HIV/AIDS,SEX DISEASES,SEX WEAKNESS & ABORTION SPECIALIST
profdrram@gmail.com,07838059592, DELHI –NCR,marriage & sex counseling
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On 11 December 2013, the streets outside the Supreme Court of India thronged with a dazed crowd, hugging, sobbing and not quite sure what had happened. Inside the hushed courtroom, the judges had just passed a devastating ruling. Lesbians, gays, bisexual and transgender (LGBT) people in India had once again been labelled criminals. Section 377, the 152-year-old colonial law that banned gay sex, had been upheld by the Highest Court of Law of India saying that amending or repealing Section 377 should be a matter left to Parliament, not the judiciary.
For gay and lesbian Indians, the Supreme Court verdict means that they become vulnerable to harassment all over again. In India, domestic partnership and adoption—things that straight people take for granted—cannot even be discussed by activists because Section 377 makes it illegal to engage in gay sex. Under the colonial law, men could be jailed for 10 years for having sex with men, an act which was classed as an ‘unnatural offence’ along with paedophilia and bestiality. How can one talk about rights when the legal framework makes you a criminal?
In 2001, on behalf of the Naz Foundation (India) Trust and with the help of the NGO Lawyers Collective, I began to put together the public interest litigation against Section 377. Apart from just coming out and shouting from the rooftops about our human rights, trying to change the law was the only thing we could do. The everyday harassment of gay men by police and thugs also strengthened my resolve to fight for this cause. Although gay men are rarely prosecuted under Section 377, they are often intimidated or exploited because of it.
Once, while I was coordinating the Naz Foundation’s programme for men who have sex with men’ (MSM), a whole group of our clients were badly beaten up. They were walking home from a support meeting when they were attacked by some street boys with iron bars and hockey sticks. Many of them got their heads smashed that night and had to be taken to the hospital. We knew who did it. I wanted to make a police complaint but we could not because of the law. The police had a history of raiding groups who worked with gay men and of rounding up and arresting outreach workers. We were afraid. The men who were beaten up were also afraid to speak out. They were not ready to own up to being gay publicly; they thought they would be criminalised. In the end we made no complaint.
I had begun my journey to becoming a gay rights activist when, as an 11-year-old schoolboy in Delhi, I realised I was attracted to men. I grew up surrounded by a ‘conspiracy of silence’, in which nobody even spoke of the possibility of homosexuality. I would have been happy to hear something I could latch onto or fight with, but there was just silence—a mind-numbing and suffocating silence. There was this hypocrisy—it’s okay to do what you want to do in the bedroom but you do not talk about it in the living room. I found this appalling.
I got into gay activism in my early twenties. I realized that voicing my feelings openly began to heal the years of silence and oppression that I had faced as a gay boy growing up. But before I could go public, I had to tell my mother. After having kept my sexuality secret from family and friends for a decade I came out to my mum, whose matter of fact reply was such a delightful relief for me. She said simply, “So what?”
Most gay Indians do not have the privilege of being born to such liberal parents. After confiding in my family, I began working with gay organisations, starting with the Humsafar Trust in Mumbai and then Naz in Delhi. I became an open gay rights activist. I wrote a magazine column. I did training workshops and seminars. I was vociferous in the media. I organised protests and did work with the National Human Rights Commission on the psychiatric mistreatment of homosexual patients by the medical fraternity.
Gay men are more than fifteen times more likely to contract HIV than the average Indian, and many groups lobbied for Section 377 to be overturned on the grounds that it pushes gay men underground, increasing vulnerability to HIV. The National AIDS Control Organisation (NACO), the governmental leading the response to the epidemic in India, came out against Section 377 in 2006, arguing that the law made HIV prevention more difficult. The then Health Minister of India Shri Anbumani Ramadoss and many AIDS organisations, including the India HIV/AIDS Alliance where I now work as a Director, also called for the law to be abolished in order to protect public health. Our consistent efforts did lead to a sweet victory (now turned sour) when Section 377′s criminalisation of consensual sex between adults was declared unconstitutional by the Delhi High Court in July 2009. Constitutional morality had prevailed upon public morality, but this victory was short-lived.
The 2009 ruling had a huge impact, opening the floodgates of demand for social acceptance by LGBT people. Cities including Delhi and Mumbai have held gay pride marches; young gay people and their families are being interviewed by journalists on primetime television; Bollywood films now have gay characters. Bombay Dost, a gay magazine, has been re-launched and is no longer sold furtively wrapped in brown paper. This cultural shift gave us some degree of comfort to believe that the general population was ready for real social change. But there was plenty of opposition too. Religious groups, leaders of the BJP (the Hindu nationalist party), and hundreds of millions of ordinary Indians, especially those in rural areas, still find homosexuality unacceptable.
This social discrimination will be much harder to change now that the law again upholds it instead of denigrating it. In small towns of India, it is still not easy for people to reveal their sexual orientation to their family. Even in Delhi, young gay men need guidance and support to come out. Gay men succumb to the social pressure around them and keep their sexuality secret. When I was in my late teens I asked a man I met at a cruising spot whether he would ever get married (to a woman). “I already am,” he replied, “Isn’t everyone?”
But despite these challenges, things can improve if we choose to believe in ourselves. When I chose to come out and start working as a gay rights activist, I used the very stigma which tried to oppress gay men as a weapon to create my own life of freedom and help others along the way. Today I am not only a political activist working on sexuality issues but also a writer on the subject. My sexuality, a source of anxiety in my early years, has defined, quite successfully, who I am and what I have chosen to do with my life.
And even as I write this, the Government of India has appealed to the apex court seeking a review of its judgment on Section 377, saying that ruling falls foul of the principles of equality and liberty. Let us hope that all our rights will once again be preserved.
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SCAPE 377 IPC BUT KILL HIV STIGMA IN LGBT COMMUNITY
Posted by on Monday, 23rd December 2013
HIV STIGMA PRESENT IN LGBT COMMUNITY,HIV STIGMA KILLING IN LGBT /HINJARA COMMUNITY -BY A LGBT PATIENT MR. Ledford PROF.DRRAM ,HIV/AIDS,SEX DISEASES,SEX WEAKNESS & ABORTION SPECIALIST profdrram@gmail.com,07838059592, DELHI –NCR,marriage & sex counseling FOLLOW ON FACE BOOK:www.facebook.com/drramkumar FOLLOW ON TWITTER:www.twitter.com/profdrram MR.LEDFORD STATES THAT I have touched on this subject before but I feel passionate about it and I think it is something that really needs to be discussed more in the GLBTQ community. We all talk about erasing the stigmas related to HIV and how people need to be educated on the subject, which I fully support and believe in, and also in the GLBTQ community we talk about wanting equality and to just be treated like the rest of humanity, which I also support and agree with. BUT ... We can not erase stigmas or be treated as equal until we start treating each other as equals. I can not tell you how many times I have heard stories about people in the GLBTQ community telling each other not to talk to somebody just because that person has HIV or it is rumored that that person might have HIV. I have had it happen to me more times than I can count. That right there is one of those stigmas that need to be erased, last time I checked you could not contract HIV from having a conversation with someone and damn really, if you could, the whole world would be infected. We all know how much the "community" loves to talk about each other, especially in the bar/club scene. For those of you who love to have diarrhea of the mouth and then drive off with your "equal love" stickers plastered all over your car, this message is for you. You can not go out preaching equal love until you treat others in our community as equals. Just because a person like me has HIV, does not mean that they are beneath you, or "dirty", or any of the other crap you want to talk about them and personally I welcome someone to come up and tell me I am "dirty," I will give them an education like nothing they have every had. I really believe that if we want to fight and erase stigmas about HIV we need to start by educating the up and coming generation. Most of the generation today is ignorant about HIV and that is simply because they are lacking education on the subject, and most of us (me included) do not remember the HIV/AIDS epidemic of the 80's or were not even around for it. I have said it before and I will say it again, I think social media should be our new frontier for fighting stigmas and for education. I mean everyone already lives plastered to their phones and stays connected to social media all day, so why not use those to reach out to the community? If we can erase stigmas the GLBTQ community and learn to treat each other as equals, then and only then can we start to erase the stigmas in the rest of the world and be seen as a EQUAL UNITED COMMUNITY. We all want the same thing and that is just to be loved, so why single a group out because of something like HIV?
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GAY/ LESBIAN MORE HIV DUE TO ANAL SEX ,MORE ANAL CANCER AND CERVICAL CANCER IN VIRGIN GIRLS DUE TO HPV
Posted by on Monday, 23rd December 2013
HIV MORE SEEN IN GAYS AND LESBIANS AS MOSTLY SAFE AND PROTECTED SEX IS NOT PRACTISED ,SECONDLY IF LESS REPORTING OR CRIMININALITY ATTACHED THEN LGBT COMMUNITY WILL HIDE IT AND SO MSM OR HIJRA OR TRANS GENDER SEX WILL BE HIGH AND RESULTING IN MORE HIV /AIDS,SECONDARILY THIS ANAL SEX LEADS TO INCREASED ANAL CANCER BECAUSE OF HIGH HPV AND HIV INFECTION.HPV HAS BEEN SEN IN VIRGIN FEMALE TOO IF ANAL SEX OR RUBBING OF BODIES BETWEEN INFECTED FEMALES OCCUR ALTHOUGH FEMALE IS VIRGIN ,SO NOWPAP SMEAR TO SEE CERVICAL SCREENING IN VIRGIN FEMALE IS ALSO ADVISED IN UK AND USA AS HPV MAY INFECT VIA ANAL SEX OR TOYS OR BY BODY OR ORAL CONTACT OR SEX.
THERFORE ON ADVICE OF NACO AND LGBT SOCIETY GOVT OF INDIA HAS FILED REAPPEAL TO CURB 377 OR FREE LGBT SOCIETY AND LET THEM TO TAKE AS NORMAL PERSON WITHOUT CRIMINALITY,DISCRIMINATION AND STIGMA
An article in Medical Xpress showed that older HIV-infected men who have sex with men (MSM) are at higher risk of infection from the strains of human papilloma virus (HPV) that cause anal cancer. HPV, which causes cervical cancer in women, also can cause anal cancer in both women and men.
Researchers from the University of California, Los Angeles (UCLA) School of Nursing, led by Dorothy J. Wiley, associate professor at UCLA School of Nursing, reviewed data on 1,200 men from four U.S. locations. Participants were examined twice a year for 25 years. During semiannual visits, healthcare providers examined all participants for demographic, sexual, behavioral, and HIV-infection characteristics as well as tested for HPV. Approximately 49 percent of the participants were HIV-infected.
Findings showed that HPV infection was common among the participants, and the proportion of participants with HPV was high among 40-69-year-olds. HIV-infected participants from this same age range had a higher risk of HPV infection than participants not infected with HIV. HIV-infected participants taking antiretrovirals as prescribed had a lower risk of acquiring the HPV infections that cause cancers. Also, not using tobacco lowered the risk of HPV infections for all participants.
Wiley noted that the findings highlight the benefit of adhering to treatment for HIV-infected MSM as a means of cancer prevention. This study also demonstrates the need for developing more effective HPV infection prevention, including vaccination of age-eligible males and screening and treatment for high-risk MSM.
The full report, "Factors Affecting the Prevalence of Strongly and Weakly Carcinogenic and Lower-Risk Human Papillomaviruses in Anal Specimens in a Cohort of Men Who Have Sex With Men (MSM),"
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HIV /AIDS TRETMENT START HIV SOON IRRESPECTIVE OF CD4 COUNT
Posted by on Monday, 23rd December 2013
HIV /AIDS WHEN TO START TRETMENT :PREVIOUSLY WAS CD4 COUNT 350 LATER IT WAS 500 AND NOW EXPERT SAYS START TRETMENT AS SOON AS YOU GET HIV INFECTION DONOT WAIT TILL FULL BLOWN DISEASE OR AIDS AS WE CANNOT DENY A TREATMENT AS WE DONOT DO WIT PREGNANT WOMAN WITH HIV OR WITH HEPATITIS B OR C OR WITH TB OR WE DONOT DENY ANY CANCER OR OTHER INFECTED PERSON TO WAIT FOR TREATMENT TILL DISEASES APPEAR FULL BLOWN SO WE CANNOT DENY TREATMENT AS NOW A DAYS GOOD MEDICINES HAVING LESS SIDE EFFECTS PRESENT AND SECONDLY COST OF TREATMENT FOR PATIENT IS ALSO VERY LESS THAN 02 DECADES BACK'
START HIV/AIDS TRETMENT AS SOON AS YOU DETECT DISEASE AS IT PROVIDES BETTER CARE NO OPPURUNISTIC INFECTION NO SPREAD TO CO PARTNER OR FAMILY MEMBERS OR CHILD OR TREATING HEALTH WORKERS
PROF.DRRAM ,HIV/AIDS,SEX DISEASES,SEX WEAKNESS & ABORTION SPECIALIST
profdrram@gmail.com,07838059592, DELHI –NCR,marriage & sex counseling
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The World Health Organization’s new recommendation that people with HIV begin treatment with antiretroviral drugs sooner rather than later doesn’t go far enough, according to a prominent immunologist at the University of California, San Francsico Medical Center.
On Sunday, the WHO changed its position on how long people should wait before they start taking ART, a trio of virus-fighting drugs known as the HIV cocktail. In 2010, the health experts said treatment should begin after the number of CD4 immune system cells dropped below 350 per cubic millimeter of blood. Now they say the threshold should be 500 cells per cubic mm of blood. The health agency estimated the change would increase the number of people eligible for ART from 9.7 million to 26 million and avert 3 million deaths by 2025, according to a statement.
But even that is not enough, said Dr. Arthur Ammann, who has been fighting the HIV epidemic since 1981.
Ammann said the new recommendations are dangerously limited. Instead of measuring a patient’s CD4 cell count, doctors should just begin treatment immediately following an HIV-positive diagnosis.
“You’re keeping people from going on treatment that are deserving of treatment,” he said. “They deserve to have antiretoviral drugs if they’re available.”
Anmmann’s views are in line with the recommendations of the U.S. Department of Health and Human Services.
But Dr. Monica Alonso, an HIV advisor for WHO and the Pan American Health Organization, replied that there is insufficient data to support Ammann’s recommendation.
“All WHO recommendations are based on evidence,” Alonso said in an email. “Currently there is no evidence to support a ‘test and treat’ approach to all patients.” She added that WHO now recommends treatment for infected subpopulations, such as pregnant women, irrespective of CD counts.
Ammann has been treating people with HIV for more than 30 years. He co-diagnosed the first child with AIDS in San Francisco, an event he said “changed my career.” Around 2000, he decided to shift gears from the lab bench to the villages where HIV does the worst damage.
“Clinical research gave us the results we needed, but treatment wasn’t being implemented in the poorest regions of the world,” he said.
Ammann formed a non-profit organization called Global Strategies, whose mission is to provide ART to those countries most in need, such as Liberia, Zimbabwe, and the eastern Democratic Republic of the Congo.
These countries are also too impoverished to afford the CD4 cell-counting machines that are needed to make the diagnoses that fit the WHO’s recommendations. Even if they did have the machines, they couldn’t afford to provide patients with ART, he said.
Ammann suggests that the WHO’s guidelines are based on economics rather than medicine.
“They say these countries can’t afford to treat all of their patients, but that’s not really true,” he said. “Antiretroviral treatment used to cost $10,000 to 12,000 a year per patient, but now that same treatment costs $100.”
The WHO declined to respond to that charge, but emphasized that the testing guidelines were based on extensive input from outside experts around the world.
But Ammann said it’s still not enough.
“There’s never been an infectious disease or cancer in modern medical history where treatment has been withheld until the patient gets sicker,” he said. “You’re basically looking at the patient and saying, ‘I know you’re HIV-infected. I have medicine to treat you. But I’m going to let you progress to worsening of the disease until I give you the drug.’”
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