Comments on: Free HIV Drugs in India http://sepiamutiny.com/blog/2006/06/30/with_statistics/ All that flavorful brownness in one savory packet Sat, 30 Nov 2013 11:11:28 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: Jaded http://sepiamutiny.com/blog/2006/06/30/with_statistics/comment-page-1/#comment-71041 Jaded Wed, 05 Jul 2006 07:00:49 +0000 http://sepiamutiny.com?p=3536#comment-71041 <blockquote>nevirapine alone is not clinically used to prevent mother to child transmission, there are dual and triple drug therapies</blockquote> <p>The thing with single dose nevirapine(as far as I remember from med school/internship... since I dont actively prescribe ART now) is that single doses can rapidly lead to resistance, and wherever possible more complex regimens are preferred</p> nevirapine alone is not clinically used to prevent mother to child transmission, there are dual and triple drug therapies

The thing with single dose nevirapine(as far as I remember from med school/internship… since I dont actively prescribe ART now) is that single doses can rapidly lead to resistance, and wherever possible more complex regimens are preferred

]]> By: sumiti http://sepiamutiny.com/blog/2006/06/30/with_statistics/comment-page-1/#comment-71024 sumiti Wed, 05 Jul 2006 00:07:03 +0000 http://sepiamutiny.com?p=3536#comment-71024 <blockquote>On a different note, Harper's Magazine had an article a couple of months ago on 'AIDS and the corruption of medical science'. They talk about the clinical trials of nevirapine and nelfinavir. Will Nevirapine be one of those drugs that is recalled five years later because of it's side-effects which could include Liver Failure? I'm curious to know if you knwo anything about this.</blockquote> <p>I read the harper article a little while ago and it is the only one of the kind that i have read... it also only states the case of one woman. I would not discount the article completely but would definitely take its claims with a grain of salt.</p> <p>ANY drug has side effects. After some chemotherapeutic drugs, ARVs are right up there as some of the most toxic drug regiments. They do have harsh side effects and in rare cases where the reaction to the drug may be overly severe, the consequences can be lethal if the treatment is not monitored properly. That is probably the case of Joyce Hafford, mentioned in the harper report imo. But this is also true for many other therapies: for cancer, for rheumathoid arthritis etc.</p> <p>Also, as Jaded mentioned in post 19, currently, nevirapine alone is not clinically used to prevent mother to child transmission, there are dual and triple drug therapies. The combination of drugs used is based on the physicianÂ’s discretion and on the patientÂ’s HIV stage/status. There is a substantial amount of trial and error that goes into determining optimal therapy combinationsÂ… it has changed several times in the past few years and will continue to change. In the process, inappropriate drug doses and sub-optimal combinations are used and do lead to extra toxicity for some patients with downstream complications.</p> <p>Medical science is not a black and white scienceÂ… it has many shades of grey. It can be frustrating, but the challenge lies in working within the limitations to oneÂ’s best capacity and in constantly reviewing the process.</p> On a different note, Harper’s Magazine had an article a couple of months ago on ‘AIDS and the corruption of medical science’. They talk about the clinical trials of nevirapine and nelfinavir. Will Nevirapine be one of those drugs that is recalled five years later because of it’s side-effects which could include Liver Failure? I’m curious to know if you knwo anything about this.

I read the harper article a little while ago and it is the only one of the kind that i have read… it also only states the case of one woman. I would not discount the article completely but would definitely take its claims with a grain of salt.

ANY drug has side effects. After some chemotherapeutic drugs, ARVs are right up there as some of the most toxic drug regiments. They do have harsh side effects and in rare cases where the reaction to the drug may be overly severe, the consequences can be lethal if the treatment is not monitored properly. That is probably the case of Joyce Hafford, mentioned in the harper report imo. But this is also true for many other therapies: for cancer, for rheumathoid arthritis etc.

Also, as Jaded mentioned in post 19, currently, nevirapine alone is not clinically used to prevent mother to child transmission, there are dual and triple drug therapies. The combination of drugs used is based on the physicianÂ’s discretion and on the patientÂ’s HIV stage/status. There is a substantial amount of trial and error that goes into determining optimal therapy combinationsÂ… it has changed several times in the past few years and will continue to change. In the process, inappropriate drug doses and sub-optimal combinations are used and do lead to extra toxicity for some patients with downstream complications.

Medical science is not a black and white scienceÂ… it has many shades of grey. It can be frustrating, but the challenge lies in working within the limitations to oneÂ’s best capacity and in constantly reviewing the process.

]]> By: Jaded http://sepiamutiny.com/blog/2006/06/30/with_statistics/comment-page-1/#comment-70968 Jaded Tue, 04 Jul 2006 14:57:36 +0000 http://sepiamutiny.com?p=3536#comment-70968 <p>Totally agree with Sumiti... I have reasons to view the program with healthy scepticism. I worked in the hospital where the first free government ART centre in the country was set upÂ…</p> <p>One of the main problems faced was non-compliance, there are so many side effects that the patients arenÂ’t really raring to go when it comes to taking those pills. The tragedy of course is that even a few missed doses could lead to the emergence of a dangerous new mutant, with devastating consequences for everybody. Devastating for the patient as we only offer them first line therapy for free, and for everybody else as the emergence of the new mutant would also mark the end of the utility of the currently used drug (which might have taken 15 yrs and a few million dollars to develop and some more money to re-engineer and manufacture in India ;) )</p> <p>On another note, I have seen patients, sex workers with out proof of residence and ration cards who cannot get enrolled in the government program without these documents(and before you rant at bureaucracyÂ… these documents are necessary so that compliance can be assured in some way, for example in the DOTS program for TB the health worker comes home if you miss a dose)</p> <p>And the Nevirapine single dose that is being used for treatment of mother to child transmission is not the best way to go according to many reportsÂ…</p> <p>But in spite of all of this and moreÂ… itÂ’s a commendable initiativeÂ…</p> Totally agree with Sumiti… I have reasons to view the program with healthy scepticism. I worked in the hospital where the first free government ART centre in the country was set upÂ…

One of the main problems faced was non-compliance, there are so many side effects that the patients arenÂ’t really raring to go when it comes to taking those pills. The tragedy of course is that even a few missed doses could lead to the emergence of a dangerous new mutant, with devastating consequences for everybody. Devastating for the patient as we only offer them first line therapy for free, and for everybody else as the emergence of the new mutant would also mark the end of the utility of the currently used drug (which might have taken 15 yrs and a few million dollars to develop and some more money to re-engineer and manufacture in India ;) )

On another note, I have seen patients, sex workers with out proof of residence and ration cards who cannot get enrolled in the government program without these documents(and before you rant at bureaucracyÂ… these documents are necessary so that compliance can be assured in some way, for example in the DOTS program for TB the health worker comes home if you miss a dose)

And the Nevirapine single dose that is being used for treatment of mother to child transmission is not the best way to go according to many reportsÂ…

But in spite of all of this and moreÂ… itÂ’s a commendable initiativeÂ…

]]> By: Rose http://sepiamutiny.com/blog/2006/06/30/with_statistics/comment-page-1/#comment-70872 Rose Mon, 03 Jul 2006 18:55:46 +0000 http://sepiamutiny.com?p=3536#comment-70872 <p>Harper's may be radically left-wing but a couple of months back, they had an interesting article on nevirapine toxicity: http://www.harpers.org/OutOfControl.html...i can't help wonder if this Free ARVs in India has more going on in the background than is readily apparent. As someone who has worked in the field in NYC, drug toxicity among HIV patients (who may or may not have additional MICA issues going on, is something that is looked upon as the lesser of the two evils (death being the ultimate evil, i suppose)-especially if its via 'established' drugs such as nevirapine or combivir..</p> Harper’s may be radically left-wing but a couple of months back, they had an interesting article on nevirapine toxicity: http://www.harpers.org/OutOfControl.html…i can’t help wonder if this Free ARVs in India has more going on in the background than is readily apparent. As someone who has worked in the field in NYC, drug toxicity among HIV patients (who may or may not have additional MICA issues going on, is something that is looked upon as the lesser of the two evils (death being the ultimate evil, i suppose)-especially if its via ‘established’ drugs such as nevirapine or combivir..

]]> By: pk http://sepiamutiny.com/blog/2006/06/30/with_statistics/comment-page-1/#comment-70857 pk Mon, 03 Jul 2006 16:32:57 +0000 http://sepiamutiny.com?p=3536#comment-70857 <p>This is a great initiative for free ARV's for 100,000 but it really is a drop in the bucket. I'm in Punjab right now studying HIV and I'm learning anecdotally from meeting patients that the people who make the treks out to the doctors or VCT centers are really a small small minority. Most HIV positive people where I'm stationed, especially in villages, are unaware that ARV's exist and sentence themselves to dying a quick death, without seeking the help of professionals. I second the call for prevention, with a very strong need for AWARENESS building. Education is the most important social vaccine to HIV out there.</p> <p>Special thanks to sumiti, I learned a lot from your comment.</p> This is a great initiative for free ARV’s for 100,000 but it really is a drop in the bucket. I’m in Punjab right now studying HIV and I’m learning anecdotally from meeting patients that the people who make the treks out to the doctors or VCT centers are really a small small minority. Most HIV positive people where I’m stationed, especially in villages, are unaware that ARV’s exist and sentence themselves to dying a quick death, without seeking the help of professionals. I second the call for prevention, with a very strong need for AWARENESS building. Education is the most important social vaccine to HIV out there.

Special thanks to sumiti, I learned a lot from your comment.

]]> By: UberMetroMallu http://sepiamutiny.com/blog/2006/06/30/with_statistics/comment-page-1/#comment-70833 UberMetroMallu Mon, 03 Jul 2006 09:19:01 +0000 http://sepiamutiny.com?p=3536#comment-70833 <blockquote>We need to promote casual discussion of safe sex in India and worldwide way before we start believing that our problems can be solved with pills.</blockquote> <p>Erm, perhaps we should start off by ensuring that it is safe to discuss casual sex in India:)</p> We need to promote casual discussion of safe sex in India and worldwide way before we start believing that our problems can be solved with pills.

Erm, perhaps we should start off by ensuring that it is safe to discuss casual sex in India:)

]]> By: mouse http://sepiamutiny.com/blog/2006/06/30/with_statistics/comment-page-1/#comment-70829 mouse Mon, 03 Jul 2006 06:56:50 +0000 http://sepiamutiny.com?p=3536#comment-70829 <p>as a mouse in the medical profession (read mouse as: scutmonkey, rat, lowest in the ranks i.e. medical student) the more I study disease the more I realize that best cure is prevention...not "cure" as in the ARV's which essentially allow the person to live longer to further infect or create worse mutant versions of the HIV with others. Now I am not saying that the people who have the disease should be ignored but the media and the government should realize that the presentation of this news should be: Health authorities in India are accelerating a campaign to promote safe sex, with a secondary mention of the pills.</p> <p>We need to promote casual discussion of safe sex in India and worldwide way before we start believing that our problems can be solved with pills.</p> as a mouse in the medical profession (read mouse as: scutmonkey, rat, lowest in the ranks i.e. medical student) the more I study disease the more I realize that best cure is prevention…not “cure” as in the ARV’s which essentially allow the person to live longer to further infect or create worse mutant versions of the HIV with others. Now I am not saying that the people who have the disease should be ignored but the media and the government should realize that the presentation of this news should be: Health authorities in India are accelerating a campaign to promote safe sex, with a secondary mention of the pills.

We need to promote casual discussion of safe sex in India and worldwide way before we start believing that our problems can be solved with pills.

]]> By: MoorNam http://sepiamutiny.com/blog/2006/06/30/with_statistics/comment-page-1/#comment-70815 MoorNam Mon, 03 Jul 2006 00:09:36 +0000 http://sepiamutiny.com?p=3536#comment-70815 <blockquote> <blockquote> <p>Free HIV Drugs in India</p> </blockquote> </blockquote> <p>Free Kerosene: We know how well that worked. Adulterated kerosene which blew up stoves in housewives' faces. Free Sugar: We know how that worked. Adulterated Sugar mixed with mica and limestone which drove boys and men to the hospital for phallus operation due to crystals stuck in their... Free Rice: We know how that worked... Free mid-day meals: How many food poisoning cases happen to young children... Free this ... free that...</p> <p>And now free Aids drugs. Can't wait to see how this blows up in their face. Of course, a whole lot of innocent lives would end, but hey, you can't make an omelette without breaking some eggs!! Somebody needs this reward, that grant, this tour, that offsite meeting. People with inflated egos making centralised decisions, getting kickbacks, building lavish bunglows, sending their children to Yameriga to study.</p> <p>I've seen that movie before.</p> <p>M. Nam</p>

Free HIV Drugs in India

Free Kerosene: We know how well that worked. Adulterated kerosene which blew up stoves in housewives’ faces. Free Sugar: We know how that worked. Adulterated Sugar mixed with mica and limestone which drove boys and men to the hospital for phallus operation due to crystals stuck in their… Free Rice: We know how that worked… Free mid-day meals: How many food poisoning cases happen to young children… Free this … free that…

And now free Aids drugs. Can’t wait to see how this blows up in their face. Of course, a whole lot of innocent lives would end, but hey, you can’t make an omelette without breaking some eggs!! Somebody needs this reward, that grant, this tour, that offsite meeting. People with inflated egos making centralised decisions, getting kickbacks, building lavish bunglows, sending their children to Yameriga to study.

I’ve seen that movie before.

M. Nam

]]> By: sumaya http://sepiamutiny.com/blog/2006/06/30/with_statistics/comment-page-1/#comment-70791 sumaya Sun, 02 Jul 2006 16:40:37 +0000 http://sepiamutiny.com?p=3536#comment-70791 <p>hi, i'm new here to the forum. just thought i'd drop in n say hi. i've been reading for awhile, and i think u guys r awesome! :)</p> hi, i’m new here to the forum. just thought i’d drop in n say hi. i’ve been reading for awhile, and i think u guys r awesome! :)

]]> By: hairy_d http://sepiamutiny.com/blog/2006/06/30/with_statistics/comment-page-1/#comment-70778 hairy_d Sun, 02 Jul 2006 05:28:51 +0000 http://sepiamutiny.com?p=3536#comment-70778 <blockquote>hello - cbc had a piece last night on Thailand's war against aids - </blockquote> <p>my error. credit where it's due. the piece was broadcast on radio netherlands - July 1 - <a href="http://www.radionetherlands.nl/radioprogrammes/agoodlife ">this is the link</a> and it talks about bangkok's mercy center. touching story about a grandmom who was scared of contracting hiv from her grandson who was born hiv+, but took care of him nonetheless - the mercy center helped in dispellign myths etc.</p> hello – cbc had a piece last night on Thailand’s war against aids –

my error. credit where it’s due. the piece was broadcast on radio netherlands – July 1 – this is the link and it talks about bangkok’s mercy center. touching story about a grandmom who was scared of contracting hiv from her grandson who was born hiv+, but took care of him nonetheless – the mercy center helped in dispellign myths etc.

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