The successful treatment of three COVID-19 patients in Rajasthan recently with anti-HIV drugs has given rise to speculation that Indian doctors have found a cure for the deadly disease. However, this is only half the picture for the following reasons.
- There is still no prescribed treatment or preventive protocol for COVID-19
-The anti-HIV drugs are not being administered alone but are being given in conjunction with anti-malarial and anti-swine flu tablets
- Anti-HIV medicines are being used only for high-risk cases whose criteria have been clearly specified by the Indian Council of Medical Research
The treatment for COVID-19, the disease caused by the novel Coronavirus, has pushed many scientists and doctors around the world to fast track their research leading them to actively experiment with drugs depending on the symptoms exhibited by infected patients.
What Happened In Jaipur?
Rajasthan reported its first two cases of two Italian nationals in their 60's at Sawai Man Singh Hospital, Jaipur on March 3, 2020. These two individuals and a third individual who returned from Dubai faced respiratory issues and were on ventilation. The doctors at the Jaipur Hospital tried a combination of anti-HIV drugs Lopinavir and Ritonavir after researching about the same through various papers.All three patients tested negative and recovered on March 12, 2020. It is to be noted that the husband passed away on March 20, 2020 due to pre-existing conditions and respiratory conditions after testing negative for COVID-19. His death has not been counted as a COVID-19 related death.
Lopinavir and Ritonavir target the protease enzyme that helps the virus to replicate and stop it from further replicating.
The case triggered frenzied reporting of India finding a definitive cure.
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Can This Medication Be Replicated?
This medication can only be replicated if the patient is older than 60 and has other health problems, according to ICMR.
In Kochi, a British national with pre-existing health issues was put on the anti-HIV drug regimen and after a round of one week of these drugs, tested negative.
BOOM's Govindraj Ethiraj recently spoke to Dr. Sudhir Bhandari, a diabetologist and a professor of medicine as well as the principal at SMS, Jaipur to understand how they went about selecting these drugs and if the treatment could be replicated.
Dr. Bhandari stated that out of the nine patients admitted to the hospital undergoing the same regimen and six of which who were on oxygen, four no longer need external oxygen.
They used the combination of the drugs with anti-malarial and anti-swine flu along with the anti-HIV medicines to stop the virus from replicating and reduce its presence in the patient's body.
Dr. Bhandari stated that the hospital went ahead with using these drugs only under close supervision and after reviewing existing studies and other scientific research. They even sought the permission of the apex bodies- Drug Controller General of India (DCGI) and Indian Council of Medical Research (ICMR) to use these medicines.
The hospital then shared their experience and results with the various medical bodies in the country.
"It is too early to discuss whether this treatment could work for everybody. I request that the medical fraternity be given the time to understand the research before calling this experiment a cure", Dr. Bhandari told BOOM. He stated that replication can only be discussed after large-scale scientific trials were conducted.
The hospital only used these drugs after they witnessed that all their three patients had chronic health symptoms which could affect their treatment.
What Does ICMR Say?
The hospital decided to share their findings as the ICMR and the Drug Controller General of India (DCGI) had permitted them to use the drugs. The Indian Council of Medical Research (ICMR) was quoted stating that the decision to use these drugs was taken by the hospital itself and it only sought ICMR's approval.
The ICMR, however, later recommended this same treatment depending on the patient's existing health conditions. The ICMR also emphasises that the patient be informed about the adverse effects of this treatment.
The ICMR along with the Ministry of Health and Family Welfare have published a document describing the clinical guidelines for effective management of COVID-19.
The document specifies conditions for which this line of treatment should be used for patients. These include less oxygen issues, reduced blood pressure, new onset of organ dysfunction, patients were older than 60 and had history of diabetes, renal failure or chronic lung disease, or are immuno-compromised.
These medicines are to be only applied on case-to-case basis and are not a treatment that can be applied for all patients currently under treatment.
Although these medicines are a line of treatment there is not enough research through randomized controlled trials proving that this is an effective cure and can be replicated universally.
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