DOI: http://dx.doi.org/10.18203/2349-3933.ijam20200078

Mortality and survival benefits in people living with human immunodeficiency virus initiated newly with Antiretroviral therapy irrespective of CD4 count

Diwakar T. N., Raghavendra B. C., Keerthi Kumar N.

Abstract


Background: HIV is a global pandemic with estimated 37.9 million people living with HIV(PLHIV) worldwide in which 23.3 million (62%) PLHIV take antiretroviral therapy (ART). In 2018 UNAIDS estimated 7,70,000 people died from AIDS related illness globally. India has around 21,40,000 PLHIV and 69,110 AIDS-related deaths in 2017 according to NACO report. This study aims to know the mortality and survival benefits in PLHIV newly initiated on ART as per test and treat policy.

Methods: A prospective observational cohort study was conducted from June 2017 to June 2018, involving 100 ART-naïve PLHIV attending this ART Centre at Hospitals attached to BMCRI, Bangalore, India. Survival analysis was done by Kaplan Meier estimates. Spectrum of opportunistic infections and their role in cause of mortality was studied.

Results: The overall survival rate was 92% at 6 months and 91% at one year after ART initiation. The mortality rate at the end of one year was 9%, out of which Pulmonary Tuberculosis is the most common cause of mortality. There was a significant increase in the CD4 count during follow up, the mean increase in the CD4 T-cell count at the end of 6 months and 12 months was 157 cells and 286 cells per cubic millimeter respectively above the baseline value.

Conclusions: In this study early initiation of ART is found to be beneficial in clinical and immunological recovery with increase in CD4 counts and reduction in opportunistic infections in PLHIV. Pulmonary Tuberculosis remains the grave risk factor for mortality among PLHIV/AIDS patients on ART.


Keywords


Acquired immunodeficiency syndrome, Antiretroviral therapy, Mortality, Pulmonary tuberculosis, Survival

Full Text:

PDF

References


HIV and AIDS in India. Avert. 2018. Available at: https://www.avert.org/professionals/hiv-around-world/asia-pacific/India. Accessed 8 December 2019.

Pandey G. The woman who discovered India's first HIV cases. BBC News. 2016. Available at: https://www.bbc.com/news/amp/magazine-37183012. Accessed 8 December 2019.

HIV Facts and Figures | National AIDS Control Organization | MoHFW | GoI . Naco.gov.in. Available at: http://naco.gov.in/hiv-facts-figures. Accessed 8 December 2019.

Global HIV and AIDS statistics-2019 fact sheet: Unaids.org. 2019. Available at: https://www.unaids.org/en/resources/fact-sheet. Accessed 8 December 2019.

Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. World Health Organization. 2016. Available at: https://www.who.int/hiv/pub/arv/arv-2016/en/. Accessed 8 December 2019.

India adopts policy to treat all people living with HIV. World Health Organization. 2017. Available at: https://www.who.int/hiv/mediacentre/news/India-treat-all/en/. Accessed 8 December 2019.

WHO. Available at: https://www.who.int/tb/areas-of-work/tb-hiv/tbhiv_factsheet.pdf. Accessed 8 December 2019.

TB Statistics India | National, treatment outcome and state statistics. TBFacts. Available at: https://tbfacts.org/tb-statistics-india/. Accessed 8 December 2019.

Bajpai R, Chaturvedi H, Jayaseelan L, Harvey P, Seguy N, Chavan L, et al. Effects of antiretroviral therapy on the survival of human immunodeficiency virus-positive adult patients in Andhra Pradesh, India: a retrospective cohort study, 2007-2013. J Prevent Med Pub Health. 2016;49(6):394-405.

Joseph N, Sinha U, Tiwari N, Ghosh P, Sindhu P. Prognostic factors of mortality among adult patients on antiretroviral therapy in India: a hospital based retrospective cohort study. BioMed Res Intern. 2019;2019:1-10.

Angdembe MR, Rai A, Bam K, Pandey SR. Predictors of mortality in adult people living with HIV on antiretroviral therapy in Nepal: A retrospective cohort study, 2004-2013. PloS One. 2019;14(4):0215776.

Bhattacharjya C, Sahu D, Patel SK, Saggurti N, Pandey A. Causes of death among HIV-infected adults registered in selected anti-retroviral therapy centers in north-eastern India. World J AIDS. 2015;5(02):90.

Rajagopalan N, Suchitra JB, Shet A, Khan ZK, Martin-Garcia J, Nonnemacher MR, et al. Mortality among HIV-infected patients in resource limited settings: a case controlled analysis of inpatients at a community care center. Am J Inf Dis. 2009;5(3):219.

Lartey M, Asante-Quashie A, Essel A, Kenu E, Ganu V, Neequaye A. Causes of death in hospitalized HIV patients in the early anti-retroviral therapy era. Ghana Med J. 2015;49(1):7-11.

Damodar B, Renu G, Rewari BB, Hegg L, Sikhamani R, Alaka D, et al. Two-year treatment outcomes of patients enrolled in India's national first-line antiretroviral therapy programme. Nat Med J Ind. 2010;23(1):7-12.

Bajpai RC, Chaturvedi HK, Bhatnagar N, Jha UM. Correlates of change in cd4 count among the HIV patients at antiretroviral treatment centres in india: cross sectional analysis of secondary data. Nat J Commu Med. 2016;7(2):71-7.

Gautam H, Bhalla P, Saini S, Dewan R. Correlation Between Baseline CD4+ T-Lymphocyte Count and Plasma Viral Load in AIDS Patients and their Early Clinical and Immunological Response to HAART: A Preliminary Study. Ind J Med Microbiol. 2008;26(3):256-8.

Kumarasamy N, Solomon S, Flanigan T, Hemalatha R, Thyagarajan S, Mayer K. Natural History of Human Immunodeficiency Virus Disease in Southern India. Clini Infect Dis. 2003;36(1):79-85.

April M, Wood R, Berkowitz B, Paltiel A, Anglaret X, Losina E, et al. The survival benefits of antiretroviral therapy in South Africa. J Infect Dis. 2013;209(4):491-9.

Low A, Gavriilidis G, Larke N, B-Lajoie M, Drouin O, Stover J, et al. Incidence of opportunistic infections and the impact of antiretroviral therapy among hiv-infected adults in low- and middle-income countries: a systematic review and meta-analysis. Clini Infect Dis. 2016;62(12):1595-1603.