HIV Specialist - June 2021 - 43

Why did you decide to become a doctor?
I
ENTERED INTO MEDICINE FOR TWO REASONS. The fi rst is because of my father. He wanted to me to study
medicine, but passed away before he could see me become a doctor. I did this as a homage to him.
Second, I wanted to become a doctor to help serve the poor. I had come from modest beginnings and had
seen the poor suff er due to a lack of medical facilities. In fact, my father died in front of me from a massive
myocardial infarction. The only doctor on duty was not in the hospital that day. Because it was a Sunday, he
was tending to the sports teams playing that day in our town. We just didn't have the medical staff available
to save him.
Tell me about your medical training.
I completed my Bachelor's Degree in Medicine (MBBS) and residency
from Patliputra Medical College in Dhanbad, Jharkhand
in India under Ranchi University Ranchi Jharkhand.
When did you have your first introduction to
HIV care?
I fi rst learned of HIV in 1986 while still a medical student and it
fascinated me! I followed the advances of HIV very religiously by
reading whatever information was published. In those days, there
was no internet available, so I would cut newspaper and magazine
clippings to learn more. I still remember when the HIV was
isolated from tears and the Science Today issue that was completely
devoted to HIV/AIDS with a headline saying " Don't Die of
Ignorance. " I wanted to work in the area of HIV/AIDS, but there
was no training available for medical students at the time.
Finally, in 2001, the IMA College of General Practitioners in
New Delhi off ered a course which I took. That led to a Fellowship
in HIV medicine from the School of Tropical Medicine in
Kolkata. Thanks to this program, I completed my Masters and
Doctorate in HIV Medicine and passed the Academy's' HIV
Specialist credentialing exam. I began treating patients in 2007.
I now have 32 years of comprehensive medical care involving
15+ years in government rural & public health and over 17 years
in government medical colleges, rising to the level of Associate
Professor and Joint Director Care Support & Treatment (JD
CST) at Jharkhand AIDS Control under National AIDS Control
Organization.
Where do you currently practice?
I currently practice in a private practice in Jamshedpur where I see
HIV positive patients. There are some people with HIV that prefer
to be seen at government ART centers because they can get free
medications there. If my patients can't aff ord care, I also send them
to the ART centers and instruct them to come back to me for follow-up.
The more complex cases are usually hospitalize and treated.
SHUTTERSTOCK/ STEFANO TRONCI
How has HIV care and treatment changed
since you entered the field?
Many things have changed. When we started treating patients,
there were no viral loads available and treatment used to be started
at CD4 cut off points. Earlier it used to be at CD4 < 200/mm3, then
it was increased to 350 and then to 500. Finally 'Test and Treat' was
launched in April 2017 irrespective of any stage or CD4 count.
Initially, we used to prescribe Zidovudine/Stavudine +
Lamuvudine + Nevirapine, then Nevirapine was substituted
with Efaviranz. Then Stavudine was phased out. Next,
Didinosine was less and less used and Zidovudine was changed
with Tenofovir (TDF). Many new antiretrovirals (ART)
became available such as Atazanavir, Lopinavir, Darunavir,
and Dolutegravir. Now, Dolutegravir has been a game changer.
Present regimen followed in India is Tenofovir, Lamuvudine
and Dolutegravir.
Similarly, we now have better modalities for HIV testing and
monitoring treatments.
I have also seen a reduction in stigma among people with HIV
(PWH) thanks to the passage of The Human Immunodefi ciency
Virus and Acquired Immune Defi ciency Syndrome (Prevention
and Control) Act 2017, which was passed September 10, 2018. It
aims to prevent and control the spread of HIV/AIDS in India and
provides penalties for discrimination against those aff ected by
the virus. There have been laws passed decriminalizing homosexuality
(section 377) and adultery (section 497).
What is the current data on HIV in India (how
many new cases per year, deaths, etc)?
India, the second most populated country in the world with 1.35
billion people, is home to an estimated 2.349 million PWH, the
third-highest population globally after South Africa and Nigeria.
India has an HIV prevalence of 0.22 percent (0.17-0.29%). While
overall prevalence at the national level continues to be low, the
prevalence is much higher in specifi c locations and population
groups.
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HIV Specialist - June 2021

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