RESEARCH ARTICLE


Long-Term Impact of First-Line Anti-Retroviral Therapy on HiV-1 Positive Patients: A Retrospective Study in Karnataka, India



Aishah Khan1, Basavaprabhu Achappa1, Vaman Kulkarni2, Ramesh Holla2, *, Nikhil Victor Dsouza1, Bhaskaran Unnikrishnan2, John T. Ramapuram1, Deepak Madi1
1 Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
2 Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India


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Creative Commons License
© 2022 Khan et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India Tel: +919741736093; E-mail: ramesh.holla@manipal.edu]


Abstract

Purpose:

In resource-limited settings like India, the treatment efficacy of ART is monitored through CD4 count and clinical indicators. The objective of this study is to assess outcomes and indicators of treatment failure in patients on long-term first-line ART.

Methods:

We carried out a retrospective study using data from 851 patients collected from ART centers established in two tertiary care hospitals of Kasturba Medical College, Mangalore. All HIV-1 positive patients initiated on first-line therapy from 2001 to 2009 were monitored.

Results:

Of the 851 patients, 62.6% were males, median age was 37 years and 90% were infected through heterosexual contact. About 21% of the total patients surveyed were reported to have died, 2.5% withdrew treatment, 2.5% were transferred out and 1.5% were lost to follow up. Moreover, 11.2% of the population were reported to have switched to second-line therapy due to poor adherence (p=0.0001). Of those evaluated for failure (n=95), 36.8% were due to both immunological and virological failure, and 34.7% were due to virological failure. Median CD4 count at initiation was 260 cells/mm3, while the median recent CD4 count was 555 cells/mm3. In our study, an association between adherence with outcome was found to be statistically significant.

Conclusion:

To conclude, this study proves that better adherence led to a favorable long-term outcome.

Keywords: CD4 count, Adherence, HIV, India, Viral load, ART.