HIV at SRH, Part 2

After our meeting with Dr. Reddy, we proceeded to the HIV wards at SRH. This has become one of my favorite activities when I visit Hyderabad. The HIV wards consist of four adjacent rooms in a one-story building near the north end of the campus. Across the dirt road is another one story building, which houses the mess hall for the patients and the visitors. The medical officer in charge of adult HIV care is Dr. Suguna, and every time I go to SRH, I have the privilege of making rounds with her and hearing about all the cases. At any given time, there are about 10 women and 10 men hospitalized there.

Today Dr. Suguna was eagerly anticipating our arrival and had prepared a powerpoint summary of the ward activities since the inception of the Care and Support Centre in March 2006. They have had some 800 admissions in that time, and the complexity of the patients has steadily increased. We heard about the spectrum of opportunistic infections they have seen, the relatively steady mortality rates, and the challenges they have faced in terms of making firm diagnoses. There was visiting infectious diseases fellow from Vellore Christian Medical College. She was rotating through to get experience in inpatient HIV and was also helping to improve their methods to identify diarrheal pathogens.

Diarrhea is an important complication of HIV, ranking just behind TB here in India. Determining the cause of diarrhea can be tough with limited resources; bacterial, viral, and protozoal pathogens are all common. There is a small lab area in the building with the capability to do CBC, BUN, creatinine, and some microscopy. Other tests need to be referred to outside labs. For CD4 cell counts, as well as for initiation of ART, patients are taken to a local government-sponsored ART Centre, usually at the Chest Hospital. I hope that the lab capacity at SRH can increase, since it would clearly benefits the inpatients immensely.

The Care and Support Centre was recently upgraded to Community Care Centre. It looks like this is going to be a new model for HIV primary care in these parts. The patient population, and potentially the complications of HIV, will likely be different than those seen in tertiary care centers. Dr. Suguna, Tara, and I decided to discuss the current literature on HIV inpatients in India on Thursday morning, to put the SRH experience in context.