While the debate on the right drug for HIV continues, 45 % HIV+ patients are still using Stavudine that was termed unsafe by WHO
While the debate on the right drug for HIV continues, 45 % HIV+ patients are still using Stavudine that was termed unsafe by WHO
More than 1 lakh HIV positive people in India are currently using a drug, which is termed by World Health Organisation as having irreversible and long term side-effects.
The drug Stavudine that is being used as a first line therapy drug for patients is now embroiled in a controversy as WHO has warned countries to phase out the drug, while Indian authorities say they find nothing wrong with the drug.
Speaking to MiD DAY, officials of the National Aids Control Organisation (NACO), said that a high-level meeting of experts was held after WHO's latest guidelines, but it was decided not to discontinue the drug at present.
"Firstly, the guidelines say individual countries should decide for themselves. Besides 45 per cent of our clients depend on this drug, which is also the cheapest drug currently available. It's not possible to phase it out so easily," said Dr B B Rewari, national co-ordinator for the antiretroviral treatment (ART) programme.
Safe option
According to Rewari, contrary to the WHO guidelines, Stavudine has been a safe drug in India as compared with others.
"Stavudine is not associated with any complications that the WHO has highlighted. In fact we use this drug only in cases where other drugs cannot be used, like where patients are anemic as it doesn't affect the hemoglobin count," said Dr Rewari.
He however added that ART centres across the country have been asked to start monitoring patients on this drug, monitor signs of illnesses that WHO mentions and submit a report by April.
According to WHO guidelines, Stavudine could lead to a nerve disorder causing numbness and burning pain in the hands and feet, and loss of body fat known as lipoatrophy or wasting. These conditions are often disabling and disfiguring.
"Our country has highest number of patients on first line therapy using this drug. In case our study finds that this drug is harmless then that could be pivotal information for the world," said Dr Rewari.
Reacting to this development, WHO officials maintained that the drug has irreversible long term side effects.
"While Stavudine is cheap and effective, the cost of managing long term toxicities will offset the initial low price advantage. The issue of Stavudine will be further discussed by the Technical Resource Group in India and by other countries," said an official spokesperson via an email statement.
Health v/s wealth
Independent experts have conflicting views on this subject. A few like Dr Sanjay Pujari, founder of HIV Medicine Association of India, said that the wait could prove dangerous for patients already taking the drug.
"Even in Indian studies this drug has proved to have long-term serious side effects. We have stopped using this drug because of its side effects. It should be stopped immediately but authorities will have to consider budget allocation," said Dr Pujari.
While some doctors like Dr S M Sapatnekar, ex-director of Haffkine Institute and AVERT society working for HIV positive people, said that the wait and watch policy is a wise decision.
"WHO has sent out an advisory, but it isn't binding. Besides no drug in treatment of HIV is free of serious side-effects so it's a question of choosing the lesser evil," he said.
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