Crying out for aid

With one of the highest growth rate of AIDS cases in the world, India sees a boom in 'opportunistic infections' baffling doctors

By Max Martin
Published: Wednesday 15 May 1996

Bodyblow: the healing touch st (Credit: Christople De Reville)A DELHI truck driver developed recurring headaches which common drugs failed to cure. Doctors at I premier hospital tested his cerebro-spinal fluid (CSF) for possible brain irifection. Result: normal. Six weeks later, he came back complaining of unbearable headache.

His CSF sample was sent to the National Institute of Communicable Diseases (NICD) where experts diagnosed that he had cryptococcosis - a fungal disease causing meningitis (inflammation of membranes covering the brain). The first tests failed because the CSF did not show characteristic cryptococcus infection, as the patient bad little immure response. He had AIDS.

As reported AIDS cases in India showed a mind rattling 42-fold increase from 1992 to 1995 - one of the world's highest increase rates - doctors are confronted by hard- to-diagnose and hard -to-treat 'opportunistic infections'.

At an NICD expert committee meeting in February end, it was pointed out that Indian hospitals are unprepared and ill equipped to handle such cases. L'Varmus bacterial, fungal and other diseases are showing up all over the country," says NNICD director K K Dutta.

The meeting mooted a national programme for surveillsince and management of opportunistic infections, As India could not check the spread Of HIV infection, management of infections was ruled as the next best option.

we takes five to 10 years to become "full-blown". Those who contracted HIV in ruid-'80s, are becoming full-blown cases now. India may already hive around 80,000 such cases,, according to the National AIDS Control Organisation (NACO) expert and former director, Indian Council of Medical Research (ICMR), S Tripathi.

NACO estimates the number of India's HIV positives to be at least two million - expected to skyrocket in the coining years. A large number of them will remain Undiagnosed, Tripathi warns. He regards the AIDS scenario all the more serious because of the information void on opportunistic infections that are cropping up.

"As-doctors here have not seen too many AIDS patients, they do not know what infections to look for, what procedures to f6flow," says an AIDS specialist with the N1( D. Referring to the broad spectrum of infections he says, " They may be hard to diagnose, as many of the diagnostic techniques are based on tests for immune response, which UDS patients lack." This will be complicated by the occurrence of uncommon Naiiatmns of common diseases plus other rare infections. Often tuberculosis (TB), lying dormant in a patient for years, sprout up once he develops AIDS. In India, TB is dormant in almost half the adult population, said a 1992 World Health Organization (WHO) report. Every year, one million uh cases are added as half a million die. With AIDS prowling in stealthily, by AD 2000, annually 200,000 More TB cases will be added, estimates WHO.

Experts say that AIDS-related TB cases could be caused by "atypical" strains of the infective bacillus. Already TR has affected half the AIDS patients in Mumbai, according to a reported statement by an expert of the metro's JJ Hospital. According to NACO clinical expert D Sengupta, as much as 60 per cent of the AIDS patients in India are likely to develop TB.

More than 60 per cent of the NICD's recorded cases of AIDS reported candidiasis - a fungal disease appearing as milky white patches on the patient's tongue and causing inflammation in the mouth and the oesophagus. Viral diseases like herpes, which causes extensive skin lesions, are common. There is bacterial, respiratory infection pneumonia and various charrheal diseases too. "The body becomes a culture medium (for disease agents)," says a specialist.

AS AIDS cases pour in, doctors face a dilemma: the question being whether to keep patients in general wards as per a health ministry directive, or segregate them. Reportedly, doctors and staff in several government hospitals have expressed reservations about treating AIDS patients. Special AIDS wards introduced in the early '90s, were withdrawn facing staff non-cooperation. The issue is complex, as internationally, AIDS patients enjoy the right to anonymity and non-discrimination which is flouted by special wards.

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