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 2009.
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
Four south Indian states Andhra Pradesh
Maharashtra
Karnataka and
Tamil Nadu
Contributes 55% of all HIV infections
NACO Annual report

4. Routes of Transmission of HIV, India, 2010-11
NACO Annual report

5. National AIDS Control Programme Phase III (NACP III) 2007 - 2012:
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
NACO Annual report

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

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

8. ART in India Free ART roll out programme – Dec 2004
Current status [Jun 2011]
ART centers - 313
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
NACO Annual report

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

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
* 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
PI’s not recommended for first line therapy

13. CRITERIA FOR STARTING ANTIRETROVIRAL THERAPY

14. NACO 2009 WHO 2010 Classification of HIV-associated clinical disease
WHO STAGE
CD4 NOT AVAILABLE
CD4 AVAILABLE
Asymptomatic 1
Do not treat
Treat if CD4 <250
Mild symptoms 2
Advanced symptoms 3
Treat
Consider treatment if CD4 <350
and initiate ART before CD4
drops below 200
Severe/advanced symptoms 4
Treat irrespective of CD4 count
Classification of
HIV-associated clinical disease
WHO STAGE
CD4 AVAILABLE
Asymptomatic 1
CD4 <350 /mm3
Initiate ART
CD4 > 350/mm3 Defer unless
HBV/HCV Rx
HIV nephropathy
Cytotoxic therapy
Mild symptoms 2
Advanced symptoms 3
Treat irrespective of CD4 count
Severe/advanced symptoms 4

15. Challenges 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