Published On : Sun, Dec 9th, 2012

“Patient consent, counselling a must before the HIV test”-Dr. Milind Bhrushundi

As AIDS Awareness Week comes to a close, Nagpur Today had a talk with Dr. Milind Bhrushundi, a prominent name in HIV treatment in the city. Following are excerpts from the interaction:

Meghna: How do you define an HIV+ patient and an AIDS patient?


Milind Bhrushundi: The HIV virus attacks CT4 lymphocytes of the body, which are responsible for immunity. The reduced CT4 count and low immunity attracts infections that we call “Oppurtunistic Infections”, which a regular healthy person will not get. HIV does not have any particular symptoms; the only signs are the numerous infections that a person with HIV gets. If there are more than two or three infections, we call it a Syndrome- the Aqcuired Immuno- Deficiency Syndrome or AIDS.

The normal CT4 count in the human body is 500. In the initial years of HIV infection, the body tries to compensate for the lost CT4 by producing more and more of them, which is why the infected person’s CT4 count is normal in the first four or five years. The person might not know that he/she is infected. When the CT4 count goes below 200 and infections come in, the person is called an AIDS patient. Before this, he/she is called an HIV+ patient.

Meghna: What is the available treatment for HIV/AIDS?

Milind Bhrushundi: There is no drug available that can kill the HIV virus. What we aim to do, is to suppress the virus so that it doesn’t affect the CT4, and the CT4 count rises. If that happens, the infections will go down, and the patient can lead a healthy life. These drugs are known as Anti Retro- viral drugs, or ARVs. They are available free of cost in government set- ups throughout India. Those who don’t want to go to government set- ups can get them for around Rs. 600 to Rs. 700 a month.

Besides ARVs, the treatment also consists of treating the diseases and infections that the patient has fallen victim to because of low immunity, such as Tuberculosis.

Meghna: What are the most common misconceptions related to HIV?

Milind Bhrushundi: There is a lot of stigma attached to HIV because of misconceptions about the way the virus spreads. HIV can only be transmitted sexually, through blood transfusions, through injection of drugs or from an infected mother to her child. You will not be infected through sneezing, coughing, mosquito bites or by spending your day alongside an HIV positive person.

Meghna: How optimistic are you about the reduction in HIV/AIDS cases in the near future?

Milind Bhrushundi: My optimism is not the point; there are statistics to prove a very positive trend. About five years ago, I would say that there are around 14,000 new infections cases per day. Today, it has come down to around 7,000 new infections per day. This is largely because of the massive awareness campaigns that have been undertaken in the past few years, especially the National AIDS Control Programme launched by the government more than ten years ago.

At the same time, there is an increase in the number of patients who are living with HIV, because of the good drugs. Hence, the prevalence has increased, though new infections have decreased in number.

Meghna: Are there any trends related to HIV that worry you?

Milind Bhrushundi: Ten years ago, the age group in which HIV was most prevalent was 30 years to 45 years. But recent surveys show that HIV positivity in the younger age group of 15 years to 24 years increasing. This is very alarming, and we need to work on that with even more awareness campaigns and capacity building.

Meghna: Does counselling play an important role in the treatment of HIV/AIDS?

Milind Bhrushundi: There has been a great rise in the number of people who live longer with HIV. There are different kinds of PLHIV (People Living with HIV) counselling, including Pre- conceptual and reproductive counselling for the HIVE positive people who now want children of their own.

Counselling also is the mainstay of treatment itself. We have different types of counselling. First comes the pre- test counselling, which is done before the HIV test. A person should be told of the possibility of having HIV, and be explained that there are treatments available and they can still lead a healthy life. HIV tests should not be conducted without the patient’s consent. Telling a person that they are HIV positive without prior information or counselling has a very adverse impact on them,

Post- test Counselling is done for both positive and negative patients. Even if a person is HIV negative, the test was recommended for a reason, and the person has nevertheless come to us with some doubt in mind. There must be some reason behind it, such as unsafe sex practices. We counsel them on safe sex practices, so they needn’t come back for testing again.

An HIV positive patient is told about the treatment options available and about Positive Living. They are also told about safer sex practices to prevent them from transmitting the virus to their spouse. Then, there is Treatment Counselling because the treatment has to be taken very seriously. Punctuality is a must, without which the treatment will fail. We do involve a family member, mainly the spouse.