Kannan V. P1, Babu Anand C2, Nehru D3
BACKGROUND
The number of people infected with the Human Immunodeficiency Virus (HIV) worldwide was estimated to be 33.2 million at the end of 2007. The introduction of Anti-Retroviral Therapy (ART) has significantly reduced morbidity and mortality in HIV-infected patients in various developed and developing countries. However, the outcome of ART in India’s National ART Programme has not been reported in detail.
The aim of the study is to-
1. Evaluate the immunological response of HIV infected adults starting Highly Active Antiretroviral Therapy (HAART).
2. Evaluate the clinical response of highly active antiretroviral therapy in HIV infected adults.
3. Assess the functional status improvement following highly active antiretroviral therapy.
MATERIALS AND METHODS
To evaluate the effectiveness of the National ART Programme at Thanjavur Medical College Hospital, we undertook a prospective observational study involving ART naive patients who were started on ART between May 2015 and October 2016. ART was offered to these patients in accordance with NACO guidelines. The regimen consisted of two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitor. The available drugs included efavirenz, lamivudine, nevirapine and zidovudine. The CD4+ lymphocyte (CD4) count (cells/μL) was estimated at baseline and at six months intervals during follow-up. Prophylaxis and treatment of opportunistic infections were in accordance with NACO guidelines. Anti-tuberculosis treatment was administered according to the Revised National Tuberculosis Control Programme guidelines.
RESULTS
Among 203 patients started on ART in this study, 3 died after completing 6 months of therapy and 17 died within 6 months of therapy. Out of the remaining 183 patients, 104 were males and 79 were females. The predominant route of HIV transmission is through unsafe sexual practice, which accounts for 84% of cases. Incidence of HIV is less common in literate population. Majority of patients were married in the category. Most of the patients tolerated CAT-I regimen (STV+LMV+NVP). Pulmonary TB is common in this group of patients. Improvement in the functional status was noted following ART in around 49-91% of patients. In this study, mean average CD4 count increased from baseline 141 cells/μL to 359 cells/μL after six months of initiation of ART. Immunological response seen in 64% of TB patients after ART.
CONCLUSION
1. Majority of HIV patients belonged to the economically productive age group of 20-40 years.
2. A high rate of immunological response was observed after 6 months of HAART.
3. Institution of early HAART was associated with a favourable clinical response.
4. Improvement in functional status level was observed among the HIV patients after 6 months of HAART.
5. The immunological and clinical response to HAART in HIV infected TB patients were similar to those of non-TB patients.
