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Facing the Challenge

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Dr. Anil Awachat: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Its dawn, I hear only the clock ticking, everyone is fast asleep in the house, and I am writing this article on AIDS. Somewhere around a year or two I started gathering information about this subject. Earlier I also used to sleep peacefully, but when I met the specialists in this area and the people affected, not only did I lose sleep but this issue bothers me even when I am awake.

We are heading towards a disaster, as this disease is spreading rapidly. So the educated and aware people have to rise to face this challenge and not wait for the reformists or social workers to do something about it. For that we need to understand this subject, and to understand this subject we need not go to a microbiologist or a immunologist. We all have the capacity to understand and we have the right to understand. When the first case of AIDS was reported in the US in 1981, India gave the matter a let go, saying that such incidences occur in the US only as we do not have homosexual or pre/extra marital relationships here. When the first AIDS case in India was reported in Chennai, we ignored it as something that happens once in a blue moon. We need not worry about such matters. When AIDS awareness programs were aired on television, they had to be closed due to opposition saying such programs create unnecessary fear among the masses.

India is one of the worst affected countries today. And sometimes also known as World capital of AIDS. This is a great financial burden for a country like India, which is already loaded with problems of poverty, economic instability and a haphazard medical system and a corrupt bureaucracy. The AIDS challenge has been overlooked by the heads of the state. India has ignored the warning given by experts at the Vancouver Conference that India will have maximum AIDS patients by the year 2005, but India has already proven this ten years earlier. Before understanding the subject of AIDS we need to understand immunity first, I passed out MBBS in 1967 and compared to that the research in this field has increased a lot. I felt like a new comer in this field, so I started tutorials with specialists at the National AIDS Research Institute at Bhosari Pune. There I met this fair bespectacled gentleman Dr. Arun Paranjpe. He taught me how the immune system works.

He showed me a diagram of various cells moving towards each other. He explained me this cell stimulates this cell, this cell inhibits this cell I was unable to understand the whole puzzle, but Dr. told me there is further more complicated network of immunity in the body. But how do these cells signal each other? I asked How do they come to know? Do they think? My curiosity was increasing, Dr Paranjpe told me experiments have proven that this is regulated by chemicals. Millions of anti bodies circulate in the body to combat the lacs of germs entering our body. There is an ongoing fight in the body between the germs and antibodies which protect us from falling sick.

Whenever an external organism enters the body, it travels through the blood or lymph nodes. It is stopped by cells called macrophages. Every cell has a secret code called HLA. Every living organism has its own HLA, which is identified by macrophages and attacked upon where by its separate protein or antigen is taken to a white cell and then taken to a T–cell. These macrophages stick to a T–cell and transfer the antigens, the T–cell identifies the antigen and when it is established that this organism is external, they send an alarm throughout the body. This is how our immune system works. This T–cell which receives the antigen immediately divides itself into numerous other cells through replication, some of which are retained as memory cells by the body. So next time when a similar organism enters the body the above procedure does not have to be repeated. These memory T–cells identify the organism immediately and the remaining T cells start secreting Lymphokine interleukin, which signals the circulating WBC in our body to protect our body. We have lymph nodes all over our body which house the WBC. This stimulates the B cells also which are a small manufacturing unit for antibodies. Each of these can create an accurate antibody in an hour, which fight the external organism and destroy it. Some of which do not respond to this procedure retain the antibody whereby the macrophages destroy the same. Some T cells turn poisonous and penetrate into the body of the external organism and destroy it and then clear out the remaining dead organisms. If these are not cleared then there are chances of attracting other cells which thrive upon these dead organisms. This is a necessary procedure where B –cell stops T cells from destroying the normal body cells.

Even after 15 years of research there is no definite cure for AIDS or even a vaccine, as every time this virus comes out of T–cell with a new subtype. There is no vaccine that would stop each subtype, this is an incurable fatal infection. The possibility of infection through intercourse is 1% but through blood transfusion it is 90%.

Questions are raised about possibility of infection through visits to the saloon, by using common combs or a mosquito bite. These are no fixed answers to this questions. Drug addicts are one major group that is responsible for spread of AIDS. I had seen the picture of the AIDS virus in the book called Frontiers published by the National Geographic. The virus is very small it is circular in shape and is pointed all over. American Scientific is a very good magazine giving detailed information about science to the common man. From an article published in the Sept ‘93 issue I came to know how the virus enters the body. The head of this virus is covered by a protein called G P 120. The most important cell in our body has this protein receptor and receives this protein accurately. So when the virus enters into the body, it fits exactly in to the T–cell end enters it. Every cell in our body has a nucleus which contains our DNA. DNA contains our genes. The AIDS virus does not contain the DNA but has a similar element called RNA. This virus cannot duplicate its RNA and so cannot replicate either. When the virus enters the T–cell, it creates its own DNA with the help of R T enzymes. and this DNA sticks to the DNA in the T–cell. And multiples to acquire the RNA. After this procedure another enzyme called Protease helps create another cell. Such numerous viruses stick to each cell, and the T–cell breaks open and the virus spreads in the body. This procedure continues… and leads to the spread of the virus. The destruction of T–cell means danger to the body. The antibodies cannot identify the T–cell immediately, and by the time it does, the T cell has multiplied already. This goes on in the body for 5 – 8 –10 years, but ultimately the T cell reduces in number and the immune system starts weakening. Usually the cell count is 1000 which reduces to 500 to 200 and when it reduces to 5 –10 cells other organisms also attack the body and the person dies. The aids virus does not kill the human but it destroys the key cells, which in turn invites other illnesses and the body becomes vulnerable to minor illnesses. There is a white colored fungi in the mouth called candida. This enters the food pipe and the route gets blocked. Even taking in water becomes difficult. The person may get severe diarrhea and weight may reduce rapidly. There is constant fever. Pneumocystis karini causes pneumonia (This is very rare in India).

Paranjpe further explained – drawing two lines, one horizontal and one vertical trying to demonstrate the reducing T4 cell level over the years. As the T4 cell reduces to a minimum in 10 years patients do not survive beyond ten years. Therefore during this period if the patient takes adequate care chances of survival increase by a few years.

I read a book by Abraham Verghese an NRI doctor called Gods Own Country who worked in Tenesses’ mountainous region. Why would such an illness come to the small town from New York or San Fransisco wondered the townspeople. But the whole village got wiped out due to AIDS. He has given heart rendering accounts of people people dying slow deaths due to AIDS. I used to think it is alright it the patient dies after ten years he at least has 10 yrs of his life. My misconception was cleared after I read the book. Firstly it is very difficult to know how the virus enters the body and how it starts breaking up the immune system. Finally the person becomes disoriented with his surroundings and it becomes very difficult for the care takers to care for him.

We have wide spread TB also in India, and when we look at people who have died due to TB one percent of them are AIDS affected. Therefore, people working in this area say that the picture of AIDS in India is same as TB. The Time magazine reported that the AIDS epidemic in India is a part of the TB epidemic. People affected with AIDS will get TB but those not affected with AIDS will also get TB. Experts say a TB patient will give TB to another 20 people. When medicines are administered to a patient with AIDS and TB he will not respond to it, as the TB bacteria is already immune to it. Aids can still be prevented but how do we combat TB? it spreads through air, spit etc.

No one knows as yet the origin of AIDS. Some say it has come from monkeys, some say it has come from Africa. The virus and bacteria keep coming up in new forms, this must have come up through mutation process. In 1981 the AIDS virus was discovered in America. San Fransisco and NewYork reported of the extremely rare cases. Pneumocystis Pneumonia and Caposi Cancer.

These occur in cases where there is very low immunity. This was declared as a new epidemic. Later USA and France came up with the discovery of the causal virus almost at the same time. During the same year tests for identifying virus came up. Eliaza, Western blot and PCR. Had our scientific world not progressed so much in the last 20 years we don’t know where we would have been. One person commented, had this same illness come up 25 years earlier half of the population would have perished. Latest technological developments in immunology include, CD 4, CD 8, B cells, DNA and RNA cloning and existence of certain liquids in them. One laboratory in America has serums of human blood stored. These old serum samples were tested according to the new tests and a sample of 1955 was found to be AIDS positive. Which proves that his illness is prevalent since1955 and was killing few people. The symptoms were found in homosexuals and an association was made between homo sexual AIDS. After some time these symptoms became prevalent in normal people also. The first picture of AIDS was American second was African and now it is Asian. The disease was discovered in 1981 and the virus in 1982, and tests were developed within a year. It was expected that a cure or vaccine would also come up within a year, but since the last 15 years we have been unable to find a cure for it.

Till date humankind has witnessed many epidemics. The plaque epidemic lead to the loss of lakhs of lives. The aids epidemic is much different compared to other epidemics. The cause of other epidemics is usually unhygienic conditions, polluted water etc. These epidemics are limited to a certain locality and time period, but its not the case with aids. More so when the prime causal factor of aids is sexual intercourse and homosexual relationships. It is very difficult to control or change sexual behavior. In case of other epidemics use can spray, insecticides, clear garbage dumps, vaccinate and control the epidemic. It is not the case with aids. You do not know how many relationships a person might be having.

I happened to witness an Aids counseling session at a center in Pune. A 25 years old HIV positive patient was sitting. The Counselor asked him – Do you have relationships with anyone other than your wife? He replied with than ashamed look Yes, once, with my maid servant. Does your wife know about it? – No – he said. After explaining him about the precautions to be taken, the wife was called. She came and sat. After the initial queries she was also posed the same question. She too replied with an ashamed look, Yes, I have relationship with a guy staying near my mother’s place. Another instance was when I was sitting in the OPD of Sasoon Hospital – and this young lad was sitting in front of the doctor. He was suffering from venereal diseases. He too replied that he had sexual relationship with 3 other women other than his wife. I was taken aback upon hearing this! My doctor friend commented, unpaid sex very rampant in India. We speak of Indian culture – you get a different picture of culture here. Speaking to Dr’s. in field is an altogether different experience. You get a picture of practices of sex in all levels of society.

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