There was a time when being infected by the human immunodeficiency virus (HIV) was tantamount to a death sentence. This is no longer true, especially in the western world. Now patients can keep the virus under control, even if they are not actually cured of it. This transformation has been due largely to the anti retroviral therapy (ART) group of drugs. HIV infection is now a chronic illness like diabetes, coronary artery disease, or rheumatoid arthritis, which all demand continual effective drug therapy, but also periodic laboratory tests and knowledgeable supervision on a long-term basis.

Unsurprisingly, affluent nations are more able to afford ART and long-term care. In Nepal for instance, some estimate that only 10 to 15 per cent of HIV patients have free access to ART. The Global Fund to Fight Aids, among others, provides grants to supply free ART drugs inNepal. This is crucial, considering 'rack' prices for these drugs run into thousands of rupees per month.

Evidence is mounting in favour of early initiation of ART to decrease the rates of death from HIV. Death results from HIV when the disease progresses to full-fledged AIDS, which manifests itself in concomitant fungal or bacterial infections in a HIV patient. Starting ART drugs in a HIV-infected patient is dependent on sophisticated laboratory tests (CD4 count, for example), available in only a few centres in Nepal.

Given these constraints, the burden of HIV treatment is a much heavier one in a resource-poor country such as Nepal. The focus has to continue to be on prevention. The good news is that a myriad of INGOs and NGOs are working on preventing HIV infection. In fact, many caregivers working with other common illnesses (chronic lung disease, typhoid, chronic renal disease, etc) that plague this part of the world complain that HIV steals all the limelight (and the funds).

Some report the incidence of HIV in Nepal at less than 1 per cent of the adult population. But on World AIDS day (December 1), let us remember that we should never be complacent about this killer disease.