Don't use anti-HIV drugs to treat seriously ill COVID-19 patients, Centre tells doctors

By Sumi Sukanya Dutta|

Express News Service |

Published: 01st April 2020 09:00 PM

For representational purposes (Photo | Vinay Madapu, EPS)

NEW DELHI: The Centre has now asked doctors treating seriously ill patients of COVID-19 to stop giving them anti-HIV drugs, recommended earlier, and instead put them on a combination of anti-malaria drug hydroxycholoroquine and antibiotic azithromycin.

In the revised guidelines on the management of COVID-19 patients made public on Tuesday night, the Union Ministry of Health and Family Welfare said, “No specific antivirals have been proven to be effective as per currently available data.”

Earlier, it had recommended using the combination of Lopinavir-Ritonavir for treating COVID-19 patients with acute respiratory distress.

The government has now said that based on the available information (uncontrolled clinical trials), two drugs may be considered as an off-label indication in patients with severe disease and requiring intensive care unit management.

“One of the drugs is hydroxychloroquine (dose 400mg twice a day – for 1 day followed by 200mg twice a day for 4 days) in combination with azithromycin (500 mg once a day for 5 days),” said the guidelines.

“These drugs should be administered under close medical supervision, with monitoring for side-effects including QTc interval.”

The government also said that these medications are presently not recommended for children less than 12 years, pregnant and lactating women.

“These guidelines are based on currently available information and would be reviewed from time to time as new evidence emerges,” the ministry said.

Sources said that the revision has come as a study published in the New England Journal said that the anti-HIV drug combination did not work in 199 patients analysed while another study from France said that the anti-malarial and antibiotic combination helped 78 out of 80 patients analysed.

There was another independent study from China to support the hydroxycholoroquine-azithromycin combination.

Doctors treating infected patients meanwhile said that the combination should be taken only under close medical supervision.

“The government seems to have done a good thing by removing the recommendation on anti-HIV drugs for treating COVID-19 patients as the evidence in its support was very thin and its side-effects were harsh,” said Dr Yatin Mehta, head critical care specialists at Medanata hospital in Gurugram.

He, however added that HCQ and azithromycin should be given to patients under strict monitoring as it has cardio-toxicity effects in patients with underlying heart issues.

The government last week had recommended prophylactic usage of hydroxycholoroquine for healthcare workers treating novel coronavirus infected patients and close relatives of those who have tested positive—even though there is no good quality evidence that the drug, used in malaria, lupus and rheumatoid arthritis, can prevent infection from SARS CoV 2.

After that, there were many reports that people -- including doctors, even those not involved in treating COVID-19 patients -- had started consuming the drug. This included a 43-year-old doctor in Guwahati who apparently died after taking a few doses of hydroxychloroquine and azithromycin—as he was already on cardiac medication.