Profile of patients undergoing third line anti-retroviral therapy
DOI:
https://doi.org/10.18203/2349-3933.ijam20203605Keywords:
ART, Darunavir, Failure, HIV, Raltegravir, Ritonavir, Third-lineAbstract
Background: India has the third largest human HIV epidemic in the world. The advent of antiretroviral drug began a revolution in the management of HIV. Recent studies have shown that an increasing number of patients experiencing virologic failure on second line Antiretroviral therapy and require third line ART.
Methods: This prospective cohort study was conducted in Regional Institute of Medical Sciences, Imphal for a period of two years, to study the clinical, immunological, and virological profile of patients undergoing third line Antiretroviral therapy and to study the early immuno-virological response to third line Antiretroviral therapy.
Results: Mean CD4 count before third line ART initiation was 95.90±111.85 cells/μl with 60% of them had CD4 count <100 cells/μl. The mean CD4 count improved significantly (p<0.005) to 246.70±123.78 cells/μl after six months and 340.70±198.57 cells/μl after one year of the therapy. At the time of initiation of third line ART, none of the patients had viral load <150copies/ml while 60% of the population had viral load >100000 copies/ml. After one year of third line ART, 80 % of the patients showed viral suppression (VL<150copies/ml). At the end of one year, the improvement in CD4 count comparing to the Viral load was significant in those who showed viral suppression (VL<150 copies/ml).
Conclusions: This study showed significant improvement in the CD4 count and viral suppression with third line medication without any major clinical adverse effect.
Metrics
References
World Health Organization. HIV/AIDS, 2020. Available at: http://www.who.int/features/qa/ 71/en.html. Accessed November 12, 2016.
National AIDS Control Organization. Antiretroviral Therapy Guidelines for HIV-Infected Adults and Adolescents May 2013. Available at: http://naco.gov.in/treatment.html. Accessed January 28, 2015.
National AIDS Control Organization. National Guidelines on Second-line and Alternative First-line ART for Adults and Adolescents May 2013. Available at: http://naco.gov.in/treatment.html. Accessed January 28, 2015.
National AIDS Control Organization. HIV estimation 2017 report. Available at: http://naco.gov.in/treatment.html. Accessed January 28, 2019.
National AIDS Control Organization. National Technical Guidelines on ART October 2018. Available at: http://naco.gov.in/treatment.html. Accessed November 14, 2018.
HIV.gov: What Are HIV and AIDS?. Available from: https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids.15 May 2017. Accessed 30 July, 2017.
Centers for Disease Control and Prevention (CDC). About HIV/AIDS. Available from: https://www.cdc.gov/hiv/basics/whatishiv.html. 2019. Accessed 9 September, 2019.
Division of AIDS (DAIDS). Table for Grading the Severity of Adult and Pediatric Adverse Events Version 2.0 November 2014. Available from: https://rsc.niaid.nih.gov/sites/default/files/daids-ae-grading-table-v2-nov2014.pdf. Accessed 30 July, 2017.
Cesar C, Shepherd BE, Jenkins CA, Ghidinelli M, Castro JL, Veloso VG, et al. Use of third line antiretroviral therapy in Latin America. PLoS One. 2014;9(9):1–6.
Khan S, Das M, Andries A, Deshpande A, Mansoor H, Saranchuk P, et al. Second-line failure and first experience with third-line antiretroviral therapy in Mumbai, India. Glob Health Action. 2014;7(1):1-10.
Eron JJ, Young B, Cooper DA, Youle M, DeJesus E, Andrade-Villanueva J, et al. Switch to a raltegravir-based regimen versus continuation of a lopinavir-ritonavir-based regimen in stable HIV-infected patients with suppressed viraemia (SWITCHMRK 1 and 2): two multicentre, double-blind, randomised controlled trials. Lancet. 2010;375(9712):396–407.
Pujari SN, Makane A, Lodha A, Bele V, Joshi K. Short-term effectiveness and safety of third-line antiretroviral regimens among patients in western India. J Acquir Immune Defic Syndr. 2014;65(2):2013–5.
Meintjes G, Dunn L, Coetsee M, Hislop M, Leisegang R, Regensberg L, et al. Third-line antiretroviral therapy in Africa: Effectiveness in a Southern African retrospective cohort study. AIDS Res Ther. 2015;12(1):1–12.
Deshwal R, Arora S. Clinical, immunological, and virological outcomes in HIV patients on raltegravir-based salvage therapy. IJSTD. 2019;4(1):1–5.
Grinsztejn B, Hughes MD, Ritz J, Salata R, Mugyenyi P, Hogg E, et al. Third-line antiretroviral therapy in low-income and middle-income countries (ACTG A5288): a prospective strategy study. Lancet HIV. 2019;3018(19).
Moorhouse M, Maartens G, Venter WDF, Moosa MY, Steegen K, Jamaloodien K, et al. Third-Line Antiretroviral Therapy Program in the South African Public Sector: Cohort Description and Virological Outcomes. J Acquir Immune Defic Syndr. 2019;80(1):73–8.
Levison JH, Orrell C, Gallien S, Kuritzkes DR, Fu N, Losina E, et al. Virologic failure of protease inhibitor-based second-line antiretroviral therapy without resistance in a large HIV treatment program in South Africa. PLoS One. 2012;7(3):3–7.
Saravanan S, Madhavan V, Balakrishnan P, Smith DM, Solomon SS, Sivamalar S, et al. Darunavir is a good third-line antiretroviral agent for HIV type 1-infected patients failing second-line protease inhibitor-based regimens in South India. AIDS Res Hum Retroviruses. 2013;29(3):630–2.
Chimbetete C, Katzenstein D, Shamu T, Spoerri A, Estill J, Egger M, et al. HIV-1 drug resistance and third-line therapy outcomes in patients failing second-line therapy in Zimbabwe. Infect Dis. 2018;5(2):1–8.
Antinori A, Lazzarin A, Uglietti A, Palma M, Mancusi D, Termini R, et al. Efficacy and safety of boosted darunavir-based antiretroviral therapy in HIV-1-positive patients: Results from a meta-analysis of clinical trials. Sci Rep. 2018;8(1):45-54.
Downloads
Published
How to Cite
Issue
Section
