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HIV Situation in India Dr Sunil Gaikwad. HIV/AIDS In India Approximate population of India: 1.21 billion (Census 2011 ) 1986: First case of HIV detected.

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Presentation on theme: "HIV Situation in India Dr Sunil Gaikwad. HIV/AIDS In India Approximate population of India: 1.21 billion (Census 2011 ) 1986: First case of HIV detected."— Presentation transcript:

1 HIV Situation in India Dr Sunil Gaikwad

2 HIV/AIDS In India Approximate population of India: 1.21 billion (Census 2011 ) 1986: First case of HIV detected in Chennai Estimated number of HIV/AIDS cases in India (2009) : 2.39 million [Females- 39% and children- 3.5% ] Adult HIV prevalence: 0.31% 10% of the world's HIV/AIDS population live in India New annual HIV infections has declined by more than 50 percent during the last decade, 2.7 lakh in 2000 to1.2 lakh in Majority of infected individuals are in 15 – 45 yrs age group, Male- female ratio – 2 : 1 Every year in India, over 100,000 pregnant women with HIV give birth NACO Annual report

3 High prevalence states NACO Annual report Four south Indian states Andhra Pradesh Maharashtra Karnataka and Tamil Nadu Contributes 55% of all HIV infections

4 Routes of Transmission of HIV, India, NACO Annual report

5 National AIDS Control Programme Phase III (NACP III) : Halt and reverse the epidemic in India by 2012 Reduce new infections by 60% in high prevalence states 40% in vulnerable states Increase proportion of PLHA receiving care, support and treatment Strengthen the infrastructure, systems and human resources in prevention, care, support and treatment programmes at district, state and national levels. Build strategic information management systems

6 Indias response to the epidemic NACO Annual report Targeted Interventions projects: 1,385 under various State AIDS Control Societies (SACS) Access to safe blood: 1,127 Blood Banks & 155 Blood Component Separation Units Syndromic Case Management 1,038 designated STI/RTI clinics, + 90 new Laboratory support for CD4 211 CD4 machines Counselling and testing services: 5,233 stand-alone ICTCs, 1,632 facility integrated ICTCs.

7 ICTC 7 Voluntary HIV testing with appropriate pre-and post- test counseling Confidentiality No Test & Treat Approach

8 ART in India NACO Annual report Free ART roll out programme – Dec 2004 Current status [Jun 2011] ART centers PLHA receiving ART from Govt including children, PLHA receiving ART from private sector- approx1,50,000. COE: providing second line ART : 10 centres of excellence and covers 1929 patients PLHA registered : 40 % of the estimated 2.39 million pts. have been identified and registered in ART clinics across the country

9 ART scale up in India NACO Annual report

10 Antiretroviral drugs available in India (2011) NRTIs Zidovudine Stavudine Tenofovir Lamivudine Didanosine Abacavir NNRTIs Nevirapine Efavirenz PIs Atazanavir Lopinavir/Ritonavir Darunavir Indinavir Nelfinavir Integrase inhibitors Raltegravir 10

11 Antiretroviral drugs available free through the public health care delivery First line antiretroviral therapy (therapy naïve) Zidovudine/Lamivudine/Nevirapine Stavudine/Lamivudine/Nevirapine Zidovudine/Lamivudine/Efavirenz Stavudine/Lamivudine/Efavirenz Tenfovir/Emtricitabine/NVP or EFV* Second line antiretroviral therapy (treatment experienced) : Zidovudine/Lamivudine/Tenofovir/Atazanavir/Ritonavir 11* Alternative first line therapy

12 NACO Guidelines 2007 Preferred regimen AZT + 3TC + NVP Alternative regimen AZT + 3TC + EFV d4T + 3TC + NVP/EFV Other options TDF + 3TC/FTC + NVP/EFV PIs not recommended for first line therapy 12

13 CRITERIA FOR STARTING ANTIRETROVIRAL THERAPY 13

14 NACO 2009WHO Classification of HIV-associated clinical disease WHO STAGE CD4 NOT AVAILAB LE CD4 AVAILABLE Asymptomatic1Do not treat Treat if CD4 <250 Mild symptoms2Do not treat Advanced symptoms 3TreatConsider treatment if CD4 <350 and initiate ART before CD4 drops below 200 Severe/advanced symptoms 4TreatTreat irrespective of CD4 count Classification of HIV-associated clinical disease WHO STAGE CD4 AVAILABLE Asymptomatic1 CD4 <350 /mm 3 Initiate ART CD4 > 350/mm 3 Defer unless HBV/HCV Rx HIV nephropathy Cytotoxic therapy Mild symptoms2 Advanced symptoms3 Treat irrespective of CD4 count Severe/advanced symptoms 4

15 Challenges 15 Low Health seeking behavior Stigma Diagnosis of OI Early diagnosis of PTB & EPTB in HIV Diagnosis of MDR and XDR tuberculosis among PLHA First line ART Raising cut of for ART initiation to CD4 350 cells cu mm. Need for introduction of viral load, drug resistance and TDM in the ART programme. Resistance to first line ART drugs PMTCT- Single dose NVP

16 Thank you


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