Imphal, August 11: Shortage of ART drugs not only in RIMS and JN Hospitals but also in the market has become a cause of serious concern for many HIV affected people in this HIV/AIDS hit State amidst report of possibility of drug resistance if those on the first and the second line of ART drugs do not have at least 95 percent drug adherence.

In view of the seriousness of the problem, a joint meeting of the NGOs working in the field of HIV was convened at the conference hall of Manipur Network of Positive People (MNP+) today.

Representatives of MNP+, Kripa Society, Care Foundation, Lifeline Foundation, Social Awareness Service Organisation (SASO), Safe Care for Advocacy Research, Meitei Leimarol Sinaisang, North East India Harm Reduction Network (NEIHRN), etc were among those who attended the meeting.

Along with a serious deliberation on the issue, the meeting drew the attention of the Government of Manipur for taking up necessary measures in connection with shortage of ART drugs at ART centres of RIMS and JN Hospital as well as dwindling stock of the same in the market.

The meeting also decided to submit a memorandum to the Health Minister for providing other life saving drugs along with ART.

Secretary of MNP+ Kh Boby said there is shortage of Effavirenz, which is an important component of the ART drug given to patients in first line at RIMS Hospital.

So there is the fear that first line patients who are taking the drug combination of Stavudine, Lamivudine, Effavirenz might develop drug resistance as there cannot be drug adherence.

Following shortage of Effavirenz tablets in RIMS Hospital, 30 bottles of the tablet had been taken from ART Centre at Imphal and the same is being administered to the first line patient on piecemeal instead of providing the full course for one month at a time.

According to ART in-charge of JN Hospital Dr Priyokumar, the remaining stock of Effavirenz in JN Hospital would not last the month of August as 10,000 tablets of Effavirenz have been taken by RIMS Hospital in second week of July.

Dr Priyokumar explained that drug resistance may develop among the first line patients who are on ART drug if there is no drug adherence.

The drug component of ART cannot be substituted.

However, if there has to be any substitution, then it should be done in accordance to the demand of the body of the patients.

Substitution of the drug components not demanded by the body would lead to non-adherence to the drug.

Non-adherence to the drug by the first line patients would ultimately result in drug resistance and increase of the viral load thereby exposing them to the danger of opportunistic infections (OIs).

If such a stage arrives then there would be no use administering ART drugs to the first line patient.

They have to switch on to drugs of the second line.

Similarly, drug of the second line would also be rendered useless, once drug resistance develops among those who are on line second treatment.

There is no other option and so far there is no alternative drug in India, Dr Priyokumar said.

Although drugs of the first line treatment are being provided free of cost to the patients under the guidelines of NACO, there are still many other patients who do not have access to this benefit.

These patients are reportedly purchasing the drugs from pharmacies in the market.

NACO is yet to provide the drugs for the second line treatment freely to the patient, so many patients who required the second line drugs are purchasing the same from the pharmacies.

However, after the drug manufacturing companies from outside the State stopped supplying the drugs required for the first and the second line treatment since July 23/24 following alleged monetary demands from underground organisations, a serious situation has also been created for the patients who have been so far depending on the pharmacies for their drug requirements.

From out of round 200 companies which have been providing the ART drugs to Manipur, 99 percent of them have stopped the supply.

So there is the possibility that after 10 days, no life saving drugs would be available in the pharmacies of Manipur, sources said.

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