“I have no choice but to take these medicines. Even if they ask me to take 10 medicines, I will take because that is the only way I can survive,” says a 38-year-old HIV positive man.

He was admitted to the JJ Hospital two years ago when he was detected with HIV. Though he has been taking the first line of drugs ever since, he has developed resistance to them. “I could not stop taking the drugs, but it wasn’t making any difference. My CD-4 count kept dropping.”

Selected from the 18 persons screened for clinical eligibility by State AIDS Clinical Expert Panel-the special panel of experts constituted by NACO-the 38-year-old along with four others was handed over the packets of seven drugs to be consumed on a daily basis by them from now on.

The criteria is patient whose CD4 count falls below the baseline after a high or persistently remains less than 100 is eligible, besides those who develop opportunistic infections and whose viral load count is 1,000 copies/ml.

The SACEP will meet every Tuesday at JJ Hospital to review the records of patients failing on first line and will decide on second line drugs for these patients. The panel will also ensure strict adherence from patients on second-line ART and will monitor them closely for adverse effects.

“Eighteen patients have been screened and five of them were reviewed by the panel. They have been given the seven tablet regime for the second line of drugs,” said Dr B B Rewari, National Programme Officer (ART), NACO.

A team from NACO comprising Dr Rewari, Dr Po-Lin Chan, WHO India office, Pradnya, M&E officer, NACO visited J J HOSPITAL to brief the members of SACEP on various technical and operational issues related to the rollout of the second-line of drugs.

Experts from Clinton Foundation and other organisations also attended this orientation session.

The rollout has to be very careful and systematic as there are no third-line drugs available in case patients fail on second-line drugs. Currently, the Clinton Foundation is providing the drugs. The drugs cost Rs 8,000 per month.

“We started work on the rollout more than two years ago with national consultations on the need and feasibility of introducing second-line drugs in view of the very high costs involved and building the capacities of institutions and related laboratories on second-line drugs and tests,” said Dr Rewari, adding, “This was followed by the formation of a Technical Resource Group (TRG) on ART at NACO which deliberated on various issues related to the provision of second line in the national programme”

The National AIDS Control Organisation (NACO) began giving free Antiretroviral Therapy (ART) in 2004, wherein JJ Hospital was one of the first centres selected.

The ART programme, which began in eight institutions, has now scaled up to 137 ART centres across 31 states. Nearly 1.2 lakh patients are currently receiving free ART treatment at these centres. Of these, 20,000 are from Maharashtra.

NACO estimates that despite very good adherence levels, nearly 3 to 5 per cent of patients become resistant to antiretroviral drugs in about three years after the treatment begins. It estimates close to 3,000 persons having ART treatment have developed resistance and need to be moved on the second line of regime.