There is a dire need to mitigate the risk of the emergence of more multi-mutational variants like Omicron in the future by increasing efforts to control advanced HIV disease, said a public health lawyer and South Asia Head of Médecins Sans Frontières (MSF) Access Campaign. In an interaction with BusinessLine , Leena Menghaney talked about how the National AIDS Control Organisation’s (NACO) implementation of the World Health Organization’s recommendations to diagnose and treat advanced HIV disease have faced multiple delays and neglect. However, the Ministry of Health can no longer afford to do so in the wake of a new variant of concern.

According to the Science magazine, SARS_CoV-2 may have mutated in people with weakened immune systems, giving rise to new variants in people with cancer or living with HIV who have an uncontrolled HIV infection. Covid infection can persist for months in such people.

Scientists in South Africa traced a sample of Covid to a 36-year-old woman who was not receiving effective HIV treatment. Tests revealed that she had a persistent Covid infection for 216 days and it accumulated into 32 mutations. This should be a matter of concern to the Ministry of Health in India.

“People with advanced or uncontrolled HIV who have a high viral load of the HIV virus are immunocompromised and if co-infected with Covid are far more likely to die from Coronavirus, and their neglect by the HIV programme could drive the emergence of Covid variants,” said Menghaney.

“According to official figures, at least 35 per cent of those people living with HIV, who come under India’s HIV treatment programme, are immunocompromised and often die of diseases such as TB, meningitis, pneumonia and severe bacterial infections. In addition, for those already on treatment, the government has not monitored antiretroviral therapy (a cocktail of three drugs) with regular viral load testing very well,” she stated.

“Viral load testing can tell if the antiretroviral therapy is working or not, but services were disrupted during the pandemic. Both for public health and individual patient’s benefit, people with advanced HIV need to be paid more attention in the HIV programme,” Menghaney further added.

NACO, which comes under the Health Ministry, is a nodal agency for formulating policy and implementing interventions to prevent and control HIV in India. According to Menghaney, NACO has no specific intervention to reach this population with advanced HIV and provide services, including Covid testing. It is a reminder that efforts to address Covid must go hand-in-hand with efforts to end AIDS in India as a public health problem.

“We need to close the gaps in the HIV treatment cascade. So we need to get everybody diagnosed. There is a need to reach people with AIDS, and provide them with diagnostics and effective treatment,” Menghaney added.

“By no means are we safe as Omicron is extremely infectious, it could reach the community level considering the past instances. There could be breakthrough infections, and it can overwhelm health systems,” she cautions.

According to a recent study, Omicron will be dominant by mid-January in the UK. “Waves in India can come at different times, and the government is already preparing the health system in advance to cope with any new waves of Covid. Interventions for information, education and counselling (IEC) measures are extremely critical at the same time,” said Menghaney.

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