Virological discordance in patients on first line antiretroviral therapy with Immunological failure in Tambaram , India
Journal Title: National Journal of Research in Community Medicine - Year 2017, Vol 6, Issue 1
Abstract
Background: A percentage of HIV patients who fail first line ART (FLA) via immunologic (i.e. CD4 cell count) criteria may have adequate HIV suppression on viral load ( discordance) .We studied the prevalence and factors for this discordance when viral load testing became available in patients enrolled in an HIV treatment program in a large tertiary care hospital in India. Methodology: A cross-sectional study of HIV patients on FLA in Government Hospital of Thoracic Medicine , Tambaram with immunological failure (IF) and who were eligible for viral load testing as determined by the State AIDS Clinical Expert Panel (SACEP).Eligibility criteria for SLA include: received FLA for at least 6 months with adherence > 95% and has failed FLA immunologically or clinically (WHO) with a subsequent failed virologic response. Concordant response was defined as IF and VL > 10,000 copies/ml, discordant response as IF and a VL < 400 copies/ml; intermediate response was defined as IF and VL between 400 and 10,000 copies/ml. Various clinical and demographic factors were analyzed between discordant and concordant groups using Chi-Square and Fisher’s exact test. Results: From January to August 2008, 106 patients were referred for SACEP. Of these, 76 (71.6%) were eligible for evaluation. In those evaluated 69.7% , 21.1% , and 9.2% had a concordant , discordant and an intermediate response. The respective baseline characteristics for discordant and concordant groups were: mean age in years 35 and 39 (p- value < 0.05) , 81.3% and 96.2% males (p- value >0.05) , median CD4 count of 51 and 56 cells/cubic millimeter (p-value > 0.05). Other characteristics of the discordant and concordant groups respectively were: median CD4 count at IF (68 vs. 96 cells/cubic millimeter; p-value > 0.05) , median time to IF (12 vs. 15 months; p-value > 0.05) , previous history of ART (6.3% vs. 37.7%; p-value < 0.05) , ART substitution (50% vs. 71.7%; p-value >0.05) , clinical failure in addition to IF (12.5% vs. 37.7%; p-value < 0.05). Conclusion: In this population , 21.1% of HIV treatment patients with IF on FLA were found to have discordant virologic response to ART. Such patients may be inappropriately initiated on more costly and potentially toxic SLA.
Authors and Affiliations
Ganesh . S. A, Rajasekaran Sikhamani, Jyoti Somani, Manoharan Gurusamy, Patrick Nadol, Raja Krishnaraj, Ezhil Radhakrishnan
Keywords
Related Articles
- EP ID EP305201
- DOI -
- Views 70
- Downloads 0
Retrospective Analysis of Demographic and Clinical Profile of Dengue Infection in a Tertiary Care Hospital
Background: Dengue infection is an exceedingly common cause of fever in the tropical countries. Aim:to study the demographic and clinical profile of Dengue patients. Design: Retrospective observational study of serologic...
A Study On Assessing The Knowledge, Attitude & Practice Among The Victims Of Animal Bites In Trichy, Tamilnadu.
Background: Rabies is highly prevalent in India contributing to 36%of world's rabies death. The main constraint for prevalence is poor knowledge among people regarding rabies. This highlights the need for creating awaren...
Prevalence Of Intimate Partner Violence And Assessment Of Risk Of Danger Among Women Suffering From Intimate Partner Violence
The Intimate partner violence is prevalent in almost all countries worldwide, both in developing and developed countries. Even-though the prevalence rate may vary among countries, the rate is high in almost all countrie...
Risk Factors of Non-Communicable Diseases in an Urban Locality of Andhra Pradesh.
Background: Chronic non-communicable diseases (NCDs) have replaced communicable diseases as the most common causes of morbidity and premature mortality worldwide. Objectives: To estimate the risk factors of NCDs in an ur...
Job Satisfaction among Resident Doctors at Assiut University Hospitals, Egypt
Background: Physician’s job satisfaction is a cornerstone for improving the quality of health care, and its continuity. This study aimed to determine the overall level and aspects of job satisfaction among resident docto...