Incidents reported after State began offering ART free of cost to infected
PEOPLE living with HIV (PLHIV) in the State are being affected with a mysterious blindness in addition to the usual ailments affecting the infected people. Though authorities claim that it is the usual blindness condition that flares up with the administration of Anti Retroviral Therapy (ART), some experts do not rule out the possibility of toxicity from a certain drug in the ART drug regimen.
Incidents of blindness have indeed been reported since the State began to offer ART for free to PLHIVs, with a few recipients of the drug regimen in the first batch going completely blind. The incident occurred at the ART Centre in Hubli, where more people have been reported with the cytomegalovirus (CMV) retinitis, a condition that causes blindness in PLHIVs with weak immune system.
Karnataka State AIDS Prevention Society (KSAPS) reasons that the surge in HIV blindness in Hubli may be due to the fact that the ART centre in the city is tertiary, which means only the PLHIVs whose CD4 counts are low visit the Centre. The Society records, available only from last year, reveal 251 cases in 2010-11 and 131 cases from April-August this year. There are reasons to believe that this is just the tip of the iceberg.
Scientific literature reveal that people having low CD4 count are susceptible to CMV retinitis once they undergo ART. This happens due to ART causing Immune Reconstitution Inflammatory Syndrome (IRIS), which exposes the virus and enables it to multiply in the body. The condition affects retina and causes loss of vision.
The progressive, irreversible condition can be treated in the early stages through medicated injections.
But these are expensive and not covered in the ART regimen, and few ophthalmologists are ready to provide the treatment for the PLHIVs. Compounding the problem is the lack of awareness both amongst the PLHIVs and the medical fraternity, resulting in patients skipping through the net in the early stages. Ideally, a person undergoing HAART (Highly Active Anti Retroviral Treatment, where triple drug combination is given) should undergo eye check up once in three months.
Kashinath, a daily wage construction worker from Hubli, has lost vision in the left eye and has night blindness in the right eye. “I did not have any vision problem before undergoing ART. But three months into the treatment, I started having problems. I have not gone to work for the last one and a half months, as I cannot see properly,” says Kashinath, who has to support his wife, two children and aging mother with a daily earning of Rs 250.
Doctors say that the infection cannot be attributed to drug toxicity if it occurs within a year. A woman from Hubli became completely blind a year and a half after starting on ART.
“It’s important that the patients are treated early,” said Dr Krishna Murthy of Vittal Eye Hospital, one of the private hospitals in Bangalore, where patients are referred to.
“We treat them for free but sometimes we have patients in advanced conditions,” he said, adding that he treats nearly three to four cases of CMV retinitis in a week.
National AIDS Control Organisation (NACO) guidelines recommend mandatory eye check-up for anyone whose CD4 count is less than 100. The extent to which this is followed is anybody’s guess.
While KSAPS has conducted sensitisation programme for all ophthalmologists in the districts in general, specific target intervention programmes have not been conducted. As a result, PLHIVs encounter stigma and discrimination from ophthalmologists.
Dr Sundar Sundararaman, a Chennai-based HIV expert, said little or no attention has been given to ocular conditions related to ART therapy because the numbers are few. While NACO acknowledges that this is a new problem coming up in the country, it hasn’t been stressed enough, says Ahmedabad-based ophthalmologist Dr Alay Banker, who treats HIV patients for ocular problems, especially CMV retinitis. He has close to 3,500 CMV retinitis cases registered from across the country in his centre.
An official from KSAPS says that CMV retinitis comprised one -two per cent of the entire spectrum of opportunistic diseases affecting PLHIV, but Dr Banker says that 15-20 per cent of people on HAART are prone to CMV virus.
(Published in Deccan Herald on 24th October, 2011; along with L Subramani) *My last article published as reporter in the newspaper