The lack of essential medicines required for the prevention and treatment of opportunistic infections is causing a lot of suffering among human immunodeficiency virus (HIV) – Acquired Immunodeficiency Syndrome (AIDS) patients. This issue has been raised by a group of experts, patient-activists and organisations in a letter sent to the Union health secretary Rajesh Bhushan and National AIDS Control Organisation (NACO) on World AIDS Day on Wednesday.

HIV attacks the immune system. Its chronic and advanced stage is known as AIDS. Due to the suppressed immunity of the infected patients, they become vulnerable to catching other bacterial, viral and fungal infections. For instance, tuberculosis (TB) is the commonest opportunistic infection among HIV/AIDS patients. Other common infections include pneumocystis pneumonia (PCP) that causes inflammation and fluid buildup in the lungs, cryptococcal meningitis, a painful fungal infection of the brain, cytomegalovirus (CMV) that commonly infects the gastrointestinal tract, toxoplasmosis, a parasitic infection that causes muscle pain and fever among other infections.

“There is a range of medications indicated for HIV/AIDS patients in order to keep these opportunistic infections at bay, boost the immune system and reduce the side effects of existing medications,” said activist Ganesh Acharya, who is one of the 24 signatories to the letter sent to the government. “But many of these drugs are unavailable or irregularly available in the public sector. For instance, fluconazole, a common and cheap medication to treat fungal infections are never available in centres. Another important medication known as pyridoxine recommended for HIV patients to tackle the vitamin B6 deficiency is always unavailable,” he said.

According to Acharya, despite the revised National AIDS Control Programme (NACP) IV emphasising the management of opportunistic infections, most centres delay prescribing these medicines. He cited a case of a 50-year-old Thane resident who was diagnosed and registered in anti-retroviral therapy (ART) in Mumbai but was never prescribed any of the preventive drugs despite his CD4 cell count being below 200. CD4 cells are white blood cells that fight infection in the body. A low CD4 count is an indication to put HIV patients on preventive therapies as they are bound to catch opportunistic infections.

“Many of these patients are already malnourished, and their nutritive intake does not match the level required to combat the impact of medications they take,” said Elizabeth Selhore, co-founder of Pune-based no-profit Sahara that works in the field of drug use and HIV/AIDS.

“Preventive therapies and drugs to tackle the opportunistic infections are therefore crucial for their survival and good health,” she said adding that some of the common drugs that were earlier available under the NACP are not given anymore.

In their letter, the activists and organisations have urged that the drugs should be procured centrally by the NACO for better availability. “Even today, in the era of antiretroviral therapy, we are losing people living with HIV to AIDS-related illnesses such as TB, pneumocystis pneumonia, cryptococcal meningitis, CMV, and toxoplasmosis,” said the letter. “We are concerned that people living with HIV 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,” it added.

Mumbai-based infectious disease expert Dr Vasant Nagvekar (not a signatory) said that opportunistic infections become life-threatening for HIV/AIDS patients. “The sooner the treatment for such infections is started, the better for patients to cope,” said Dr Nagvekar adding that the number of HIV cases has come down over the years only because the ART treatment is started soon as a person tests positive, unlike earlier when ART was started only after the CD4 count reached a certain level.