Sunday, 28 July 2013

Readers' queries relating to HIV/AIDS will be answered in this section by a special panel of experts including

vinay kunkarniVinay Kulkarni, a physician specialising in treatment related to HIV/AIDS. He is associated with Prayas Health, a care and support organisation in Pune

padma govindan Eldred Tellis is director of the Sankalp Rehabilitation Trust, Mumbai, and a member of NACO’s Technical Resource Group for programmes related to injecting drug users. He has worked extensively in various parts of India and Asia developing and replicating programmes for IDUs

padma govindan Padma Govindan, founder and co-director of the Shakti Centre, a sexuality advocacy and research non-profit organisation in Chennai

magdalene jeyarathnam Magdalene Jeyarathnam, founder-director, Center for Counselling, Chennai

Click here to send any queries you may have

I have a friend who is an HIV patient and he is a very poor guy, so please suggest how he can avail of ARV and other treatment

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Anti-retroviral (ARV) treatment is available free of cost at a number of government centres. Visit any government hospital for information on the centre nearest you.

--Editor, hivaids.in


My blood has been tested and came back with a 9.l0 index value. Is that high? Can I wait some time and get another blood test using a different test? What test would you recommend? Also, any good books to read on herpes? My test was HSv2

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Different methods are used by different labs. The patient/client need not worry about the index values etc, but just look at the results. If the lab reports it as significant/reactive/positive then only one should go ahead with further investigations. HSV2 IgG values can be positive in many people and are indicative of past infection, which many people may have had. That does not indicate need for treatment or any serious affliction.

--Vinay Kulkarni


I am a PLHA in NCR undergoing first line of treatment since 2007. My family has deserted me. I am professionally qualified and want to adopt a male child to raise him with the same status as mine. Kindly advise and help.

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Please contact a care and support service for positive children in your area. They will be able to advise you on this matter. The positive people's network nearest you should be able to direct you to the nearest such service. Or log on to: http://www.inpplus.net/ the website of the Indian Network for People Living with HIV/AIDS, or http://positivesaathi.com/

--Editor, hivaidsonline.in


I was gay for many years, but never practised insertive anal sex. I have had oral sex may times.

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I tested for HIV in Apollo hospitals and the test was negative. I stopped having sex for many years. Recently I had anal sex with a stranger, but with a condom. I didn’t notice the condom had a tear or anything. It is three months now after the encounter. I noticed two red rashes on my skin. One disappeared and the other is still there. I also had a small wound beneath my knees which was painful to touch. I have leg pain. Should I go for an HIV test again for these symptoms?

I would suggest two things. For the skin lesions see a dermatologist. It is very difficult to comment by just reading the description of the rash. If you are worried, and as three months have already passed since your exposure, it is better to get tested.

-Vinay Kulkarni


How do I protect myself from HIV/AIDS? What are the advantages and disadvantages of ARVs?

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Information on protection is available on our website hivaidsonline.in

Anti retroviral drugs (ARVs) are the only established treatment for HIV infection. They are available free through the public health system.

ARVs have certain side-effects and require monitoring. They must be taken at fixed intervals without missing any dose. Some drug combinations are not advised for those with certain medical conditions. Drug resistance eventually develops, and this requires the person to shift to more advanced ARVs which are more expensive and generally not available through the government programme. People with HIV must also take care to eat well and protect themselves against infection.

--Editor, hivaidsonline.in


I had sex two days ago. When should I get tested? When can I get the results?

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1. Your risk of HIV infection is low if you used a condom.

2. You should test for HIV infection 3 months after you had sex; if you take the test before 3 months it may not be accurate.

3. Visit the nearest integrated counselling and testing centre in your area. The counsellor there will help you.

4. The counsellor can also tell you when exactly to test, which test they use, how accurate it is, and when the results become known.

--Editor, hivaidsonline.in


I am a doctor (neurologist) working in a government referral hospital. I wish to know whether writing the diagnosis of HIV on an HIV-positive patient's prescription

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(in cases where the diagnosis is already established and known to the patient) is permissible or whether it is a breach of confidentiality.

This is a difficult question.

Even if the person knows it, still the prescription is likely to be seen by others and unless accepted by the patient it would mean breach of confidentiality. Unless warranted due to issues such as employer's policy and accepted by the person and with full understanding of the consequences, I would suggest you not write it on a prescription.

I also do not understand why should we write anything on a prescription? If it is a shortcut for not keeping appropriate records it might be a risky shortcut especially in medico-legal matters.

On the other hand I feel that documents such as discharge cards, death certificates, insurance related papers etc should reflect the truth. However, I would still inform the person to understand the consequences of uncontrolled disclosure and take care of keeping records confidential.

---Vinay Kulkarni


I have two questions:

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(1) I am 40 years old and tested positive in 2006. My CD4 count was 12 and I started ART (consisting of Zidovudine 300mg, Lamivudine 150mg, Nevirapine 200mg) since February 2007. Now my CD4 count is 17 and viral load not detected. Should I continue with the same regime?

(2) I am 29 years old and tested positive on March 2010. My CD4 count is 375 and my viral load is 26155 copies/ml. I am planning to have a child. Should I start ART?

(1) Yes. If viral load is undetectable and your health is fine, you may continue with the same regimen. There are some patients who have little or late immunological recovery. However, I would suggest you keep following your treatment with both CD4 counts and viral loads done every six months.

(2) If your CD4 counts are above 350 then you need not start ART for your own treatment. You may plan pregnancy after giving due consideration to all pros and cons. You may start ARV for prophylaxis from 14 weeks onwards. What to take as prophylaxis could be decided in consultation with your physician. There are 2 options - using Zidovudine alone or using triple drug ART for the period of pregnancy. However, if at the time of conception your CD4 counts are less than 350, you will be required to start ART for your own sake. Follow your physician's instructions.

---Vinay Kulkarni


I was involved in sex with a sex worker. After 15 days I noticed that multiple lymph nodes in my neck were swollen and painful. I also found some lymph nodes swollen and painful in my chest, underarms and groin area.

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I also have continuous fever and sometimes diarrhoea. I went for PCR DNA HIV test after 15 days. It came back as not detected, and after two months I went for the western blot HIV test. It too came back as not detected for all GP, and after three months I got the HIV Elisa test done that also came back negative, ie, the value came back as 0.38.

I still have swollen lymph nodes and pain in my chest, groin and neck area. Should I re-test again after six months? How reliable is 0.38 HIV negative in Elisa test? I am very worried and not getting sleep at all.

Who has diagnosed all those lymph nodes in all those places - yourself or a doctor? Have you recorded the temperatures or had a feeling of warmth? Was your sexual contact protected with a condom or not? All these questions are relevant. If your ELISA test after three months is reported as negative (please ignore the cut off value of 0.38 as it is scaring you even further), you can be reasonably sure that you are not infected with HIV and should consult someone for ruling out other causes of lymphadenitis and fever. There are many causes for it apart from HIV, so do not worry only about HIV. In fact, some other causes may require more urgent attention than HIV.  

Just to confirm that you are definitely not infected with HIV, repeat a rapid HIV test at the end of maybe six months. But remember not to keep worrying till then as a person having symptoms but negative test at the end of three months is most unlikely to be HIV infected.

---Vinay Kulkarni


I had sex with a sex worker in 2002. After six months I had a master health check up and all was normal. I got married in 2004. Do I need another check-up?

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f you have had no exposure since your last HIV test in 2002, there is no need for any further HIV testing.

--Editor, hivaidsonline.in


I was involved in a non-penetrative sexual act with a sex worker. It was genital to genital rubbing through underwear. At no point of time did my or the girl's underwear come off.

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I felt some moisture though. My PCR DNA HIV test done at 52 days came as ‘Not Detected’. The test was done at Super Religare Lab. The 70 days ELISA (RAPID) done at Super Religare came ‘non reactive’. Are the above two tests reliable and conclusive. Do I need to go for additional testing at the 3 month mark?

No, you do not have to go for additional testing.

--Editor, hivaidsonline.in


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