NACO concerned over second-line drug abuse

JAIPUR. Negligence in treatment of HIV+ might cause termination of medical practitioners' registration. The Rajasthan Medical Council has released fresh instructions to doctors to strictly adhere to the national guidelines. Violation of these guidelines is likely to increase the severity of infection. All practitioners will now have to submit a quarterly report to National AIDS Control Organisation (NACO).
"Denying treatment, discrimination or negligence in treatment of a HIV positive patient is a henious offence.Such a practitioner will loose his registration and will have to face legal action," said Dr Archana Johri, registrar, Rajasthan Medical Council.
The new instructions have been released following concern expressed by NACO over abuse of second-line drugs for anti retroviral treatment (ART). NACO said, "In several instances patients were given treatment directly on second-line regime.''
A drug may be classed as second-line instead of first-line for one of two possible reasons: it may be less effective than the first-line drugs; or, it may have toxic side-effects; or it may be unavailable in many developing countries.
Adverse impact on the structured national programme and consequent burden of drug resistance among patients were stated as a few side effects of irrational use of second line drugs.
According to doctors, improper use of drugs makes the virus resistant to it. Such virus needs to be treated with second line drugs. However, if the virus becomes resistant to second line tratment it will be difficult to control. Such virus also carries the drug resistance when transferred to another person.
The ART treatment for first line is available free at 284 ART centres across the country, providing treatment to nearly 3.5 lakh patients. However, those seeking treatment at private institutions need to be more vigilant over the issue.
"An HIV patient can live for a considerable period while on continuous treatment. If the virus becomes resistant to the first line drugs, patients are gradually shifted to the second line. Thus, treatment should be initiated with the first line drugs only ----irrespective of the purchasing capacity of the patient," says another doctor.
The Rajasthan Medical Council denies having received any complaints regarding this recently. However, citing a Supreme Court verdict in 1998, the medical council said the NACO guidelines are applicable to doctors both in government and private set-up. The council has asked all the medical practitioners to review the prescribed format. A violation of the guidelines will be considered a violation of the Supreme Court orders.