DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20210436

Profile of highly active antiretroviral therapy failure human immunodeficiency virus patients at a tertiary health care centre of India: a success story of NACP

Digvijay G. Chavan, Meenakshi Bhattacharya, Madhukar Salve, Jyoti Ghatge, Ruhi Shaikh

Abstract


Background: Although HAART has successfully controlled the progression of HIV and helped to prevent the disease significantly, new challenges are heading up and ART failure despite of good adherence is becoming a major hurdle in the way of HIV control. Considering these facts present study was planned with an objective to study clinical and immunological profile of antiretroviral therapy failure HIV patients.

Methods: This observational study was conducted at ART plus centre of one of the tertiary health care centre of India from February 2018 to September 2019. Patients satisfying inclusion and exclusion criteria were interviewed by using semi-structured questionnaire and were examined and investigated for any opportunistic infections and their CD4 counts were studied.

Results: Among total 4098 patients alive on ART at present study centre 90.6% were responding well to the 1st line of ART, while 8.7% had failed to 1st line of ART but responding well to the 2nd line whereas 0.7% had failed to 2nd line and were initiated on 3rd line of ART. Failure of ART was the cause for change in regimen among 84.9% of patients. Median of rise in CD4 count at 6 months from switch to 2nd line was 137 cells/mm3.

Conclusions: Antiretroviral therapy has significantly improved outcome of the disease. Failure of ART is the major cause for change in ART regimen. Majority of patients in failure had WHO clinical stage 1 and 2.


Keywords


ART failure, CD4, Clinical profile, HIV, Immunological profile

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References


Fauci AS, Folkers GK, Lane HC. Human immunodeficiency virus disease: AIDS and related disorders. In: Jameson, Fauci, Kasper, Hauser, Longo, Loscalzo, editors; Harrison’s Principles of Internal Medicine; 20th edn. New York McGraw-Hill Companies Inc; 2008:1393-1462.

National technical guidelines on anti-retroviral treatment; National AIDS Control Organization, ministry of health and family welfare, Government of India; 2018.

National AIDS Control Organization and ICMR-National Institute of Medical Statistics HIV Estimations 2017: Technical Report. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India; 2018:21,35.

NACO, Department of AIDS Control. Ministry of health and family welfare. Antiretroviral therapy guidelines for HIV infected adults and adolescents, May 2013. Available at: http://naco.gov.in/nacp. Accessed on 23 August 2020.

Kumar N Krishnan S. Clinical, immunological and virological profile of patients with HIV infection on second line antiretroviral therapy. IOSR J Dent Med Sci. 2016;15:81-95.

Tsai HC, Chen IT, Wu KS, Tseng YT, Sy CL, Chen JK, et al. High rate of HIV-1 drug resistance in treatment failure patients in Taiwan, 2009-2014. Infect Drug Resist. 2017;10:343.

Swiss HIV Cohort Study, Schoeni-Affolter F, Ledergerber B, Rickenbach M, Rudin C, Günthard HF, et al. Cohort profile: the Swiss HIV Cohort study. Int J Epidemiol. 2010;39(5):1179-89.

Kumarasamy N, Vallabhaneni S, Cecelia AJ, Yepthomi T, Balakrishnan P, Saghayam S, Flanigan TP, Carpenter CC, Solomon S, et al. Reasons for modification of generic highly active antiretroviral therapeutic regimens among patients in southern India. J Acquired Immune Deficienc Syndr. 2006;41(1):53-8.

Cao P, Su B, Wu J, Wang Z, Yan J, Song C, et al. Treatment outcomes and HIV drug resistance of patients switching to second-line regimens after long-term first-line antiretroviral therapy: An observational cohort study. Medicine. 2018;97(28).

Hailu GG, Terefe MW, Tessema GA, Ayele TA. Rate of immunological failure and its predictors among patients on highly active antiretroviral therapy at Debremarkos hospital, Northwest Ethiopia: a retrospective follow up study. J AIDS Clin Res. 2013;4:211.

Kumari R, Kumar M, Gulati AK, Sundar S, Mohapatra SC. A study on the socio demographic profile of the attendees at the ICTC of Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh. Indian J Comm Health. 2016;28(1):42-7.

Deshpande JD, Giri PA, Phalke DB, Karle LB. Seroprevalence of transfusion transmissible infections among voluntary blood donors at a tertiary care teaching hospital in rural area of India, J Fam Med Prim Care. 2012;1(1):48-51.

Kumawat S, Kochar A, Sirohi P, Garhwal J. Socio-demographic and clinical profile of HIV/AIDS patients in HAART era at a tertiary care hospital in North-West Rajasthan, India. Int J Community Med Public Health. 2016;3:2088-93.

Literacy rate of India according to census of India 2011. Office of the Registrar General and Census Commissioner, Ministry of Home Affairs, Government of India. Available at: https://censusindia.gov.in/2011census/censusinfodashboard/index.html. Accessed on 2 August 2020.

Nayak U, Lenka S, Achappa B. Clinical and socio demographic profile of attendees at ART centre in a tertiary care hospital in Mangalore, India. Asian J Med Sci. 2015;6(5):61-5.