“I recommend dolutegravir for people living with HIV/AIDS because it has very minimal side effects and it is very easy to adhere to the treatment.”
Rama Pandian is the Director of the Tamilnad Network of Positive People (TNP+), in India.
A pharmacist-come-laboratory technician, Rama was tested positive in 1992 and has been actively involved in advocacy and access to treatments for PLHIVs (People Living with HIV) in India. He founded a state level organisation called, the Tamilnad Network of Positive People in 1995, and was one of the pioneers and founding members of the Indian Network of People Living with HIV.
Rama speaks about his personal story and treatment journey, that includes side-effects and adherence issues faced with drugs like efavirenz and nevirapine. This included “drowsiness, dreams, and unable to get up in the morning. These are major side effects and then since I could not tolerate efavirenz, I was switched to a nevirapine-based regimen. With nevirapine, adherence is very difficult even for me, so the doctors advised last year, I should go with dolutegravir. I have been taking dolutegravir without any problem until now.”
Speaking of some of the challenges in India, Rama mentions issues due to the side effects of efavirenz-based regimens and the limited provision of alternative medicines. Due to lack of good quality publicly available treatments, some PLHIV do not take their medicines regularly and do not go for follow-up check-ups to the government facilities. To solve some of these issues, a lot of Pandian’s efforts are directed towards advising PLHIV on managing side effects, through proper and timely nutrition and eating low fat food.
“Even then, it doesn’t work for some people. That’s why people are also not coming regularly to work as they get up very late in the morning and come to work very late. As some people work on a shift basis, like night duty, a lot of times they do not go to work”.
In an effort to support community-based organisations that work with PLHIV, Rama’s work is strongly focused around increased inclusion of prevention, care and support initiatives for PLHIV in government programs and policies.
In India, dolutegravir is currently only available in the private market, “the government is planning to provide dolutegravir and they’re taking initiatives. It was discussed in the technical resource group of National AIDS Control Organisation (NACO) last year (2018).”
“There are people taking DTG in the private sector for some time and are generally happy… but these are not high numbers […]. I know very few people that are taking dolutegravir and they’re doing good.”
In India, there are an estimated 2.1 million people living with HIV, of whom 49% are on antiretroviral treatment.
Source data and background details:
UNAIDS country stats – India