4/2/10: XDR-TB, or Extensively Drug-Resistant Tuberculosis, will be the next major problem to tackle in India due to its causal links to HIV/AIDS, said Dr. N. Kumarasamy at a lecture last semester. Kumarasamy is Chief Medical Officer at the Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE) in Chennai, India.
He added that the problem of TB will provide newer opportunities for Brown students to contribute their efforts and resources. During his lecture on the HIV/AIDS infection in India, Kumarasamy emphasized the importance of Brown’s collaboration with YRG CARE, saying that Brown helped the large non-profit organization to make scientific and political changes in India.
HIV in India, as in many places around the world, is stigmatized because early reports suggested that the epidemic was most common among female sex workers, truck drivers and patients attending STD clinics, said Kumarasamy. Ironically, a large number of the HIV cases today come from married, monogamous women and antenatal women. “Interviews with the women revealed that their only risk factor was getting married…Their only sex partner was their husbands,” said Kumarasamy. Despite the similar stigma towards HIV-infected people in the United States, Kumarasamy emphasized that the HIV situation in India is quite different. Unlike in the US, HIV-1 and the Subtype C, rather than Subtype B, are prominent in India, said Kumarasamy. “In India, it’s projected that 2-3 million people are infected…and heterosexual transmission still contributes to almost 96% of the transmission,” he added.
More importantly, the major differences between the cases in the US and those in India were the symptom patterns. In the US, Kaposi’s Sarcoma, a cancer, was symptomatic in many HIV-infected people, but Kumarasamy said that he had only encountered three cases of the cancer among his HIV patients. Instead, the most common opportunistic infection and malignancy among HIV-infected people in India is tuberculosis. “It not only happens in the lungs but also in the lymph nodes, the abdomen and the brain,” explained Kumarasamy. Because of the low immunity of HIV-infected people and the high prevalence of TB among HIV patients, TB creates a very large problem, he said.
In the face of these challenges, collaborations with Brown University and other American institutions have paved the way for beneficial policy changes. Initially, “[Indian doctors] referred to Western textbooks, where data is all from US patients,” said Kumarasamy. However, after noticing the major discrepancies between the HIV epidemic in the US and in India, it was evident that different materials were needed to instruct physicians in India. Support from Brown allowed Indian doctors to gather data on the pattern of infection in their country so that they could better treat their patients, said Kumarasamy.
Collaboration with Brown has also helped Indian doctors gather more information and conduct more research on the costs, effectiveness and safety of generic antiretroviral (ARV) drugs. “ARVs are terribly expensive from the US and Europe in India…and [in 1994] we had to smuggle them in for our patients,” said Kumarasamy. Fortunately, Indian companies started producing their own copies of the ARV products which was “good for my poor patients, but not necessarily for the ethics,” he said. Statistics prove that prices “came down to less than US$50 from US$5700,” said Kumarasamy. In addition, the government has made a “fantastic achievement in a short span [of time],” said Kumarasamy. It has opened up more than 200 ARV centers and put more than 250,000 patients on free ARV treatment.
However, despite this progress, there are still major medical and financial hindrances. Studies have shown that some of the antiretroviral drugs are very toxic. “If you come to our clinic, there are many, many patients with disfigured faces,” a sign of lipoatrophy, said Kumarasamy. In turn, the condition has created yet another stigmatization of HIV/AIDS.
Moreover, “because of economic issues, our standard of care is very different,” said Kumarasamy. In the US, HIV patients receive antiretroviral therapy when their T-cell count drops to 500, he said. T-cell count signifies the strength of a person’s immune system and people without HIV infection have about 700 to 1000 T-cells in a drop of blood. However in India, the “government couldn’t afford to help all people with a T-cell count of 350, so they did it for 200,” said Kumarasamy. “Scientists must work very closely [with the government]” to influence policy in the correct direction, concluded Kumarasamy.
YRG CARE, which Kumarasamy called a “center of excellence for clinical care,” provides testing, counseling, and other facilities for the over 14,5000 registered patients. Kumarasamy also said that some of the outcomes of the clinical research conducted at YRG CARE include studying the safety, tolerability and efficacy of generic ARV drugs in Indian patients; analyzing the short and long term effects of ARVs; and studying genotypic mutations. The clinic, with its student support and collaboration with US universities, continue to improve antiretroviral therapy, which, Kumarasamy said, “will lead to major survival benefits.”
The lecture was sponsored by the Year of India, BRUNAP, CFAR, AITRP, the Framework in Global Health, and the Global Health Initiative.
By Watson Student Rapporteur Kaori Ogawa ’12