Details
Category: Volume 05 Issue 07 July 2017
Hits: 1047

Title: CD 4 Response in HIV Patients on Long Term First Line ART – A Cross Sectional Study from South India

Authors: Seena Sankar, Shruthi Kulkarni, Anniamma, Chandramouli

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i7.241

Abstract

The CD4 count is the most important indicator of immune function in HIV-infected patients. It is also the strongest predictor of subsequent disease progression and survival. We conducted a study to estimate the CD4 count responses in patients who are on long term first line ART, possible predictors of the CD4 count responses & the clinical outcome in relation to their current CD 4 count. We conducted a cross sectional study on patients with HIV infection, on first line anti-retroviral treatment (ART) for at least five years. They were recruited either from medical outpatient department (OPD) /ART centre or admitted in the medical wards of a tertiary care hospital. We included 100 HIV positive patients on first line ART. The mean duration of disease was 7.47 (SD2.78) years. Mean CD4 count pre ART was 169.73 ± 82.78 mm3, post ART CD 4 count at 1, 5 and 6 years (current) were 371.90 ± 152.94, 506.44 ± 213.75 and 548.48 ± 266.44. There was significant rise in CD4 count from baseline to 1, 5 and 6 years CD 4 counts (p = 0.000). Duration of ART (p=0.01), history of default (p=0.04) and absence of OIs (p=0.03) before ART were significantly associated with immunologic failure. There was a significant decrease in opportunistic infections post ART (P=0). National AIDS control organisation (NACO) recommended first line regimens result in robust immunologic response that is sustained over a mean period of over 6 years in a majority (84%) of the patients & result in significant reductions in opportunistic infections.

Keywords: HIV, CD4 response, ART, CD4 normalisation.

References

  1. NACO guidelines for HIV AIDS management [2012].
  2. Kumarasamy N, Solomon S, Chauguturu S, Cecelia A,Flanigan T, Mayer KH. The changing natural history of HIV disease before and after the introduction of generic antiretroviral therapy in Southern India. Clin Infect Dis 2005.NOV 15:41(10):1525-8.
  3. Mellors JW, Munoz A, Giorgi JV, et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1infection. Ann Intern Med. 1997;126(12):946-954.
  4. Egger M, May M, Chene G, et al. Prognosis of HIV-1-infected patients starting highly.active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet.2002;360(9327):119-129.
  5. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America(2013).
  6. RA Hughes, JAC Sterne, J Walsh, L Bansi, R Gilson, C Orkin et al. Long-term Trends in CD4 Cell Counts and Impact of Viral Failure in Individuals Starting Antiretroviral Therapy UK Collaborative HIV Cohort (CHIC) Study. HIV Medicine. 2011-12(10):583-593. 
  7. Ujjwal Neogi, Elsa Heylen, Anita Shet, Sara Chandy, Ranjani Shamsunder, Anders So nnerborg et al, Long-Term Efficacy of First Line Antiretroviral Therapy in Indian HIV-1 Infected Patients: A Longitudinal Cohort Study 2013. PLos one 8(1): e55421.doi:10.1371/journal.pone.0055421.
  8. Bakwaga, J.Ananworanich, F.Zhang.et al. Predictors of Clinical Progression in HIV-1-Infected Adults Initiating Combination Antiretroviral Therapy with Advanced Disease in the Asia-Pacific Region. Results from the TREAT Asia HIV Observational Database. JIAPAC [2013;12(4):270-277].
  9. WHO case definitions for HIV surveillance and revised clinical staging and immunological classification of HIV related diseases in adults and children.(2013).
  10. B P Muzah, S Takuva, M Maskew, S Delany-Moretlwe. Risk factors for discordant immune response among HIV-infected patients initiating antiretroviral therapy: A retrospective cohort study. SAJHIVMED November 2012; Vol. 13, No. 4
  11. Mellors JW, Munoz A, Giorgi JV, et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1infection. Ann Intern Med. 1997; 126(12):946-954.
  12. Manisha Ghate, Srikanth Tripathy, Raman Gangakhedkar, Madhuri Thakar, Jayanta Bhattacharya,Ipsita Choudhury et al .Use of first line antiretroviral therapy from a free ART programme clinic in Pune, India - A preliminary report Indian J Med Res 137, May 2013, pp 942-949
  13. Rohit Goel, M Rai, Chakravarty, LP Meena, Narendra K Tiwary, Shyam Sundar et al. A Clinical Profile and Response to First-Line ARV in HIV Patients from Eastern UP and Bihar: A Retrospective Study April 2013.VOL. 61
  14. Mulla SK, Shrivastava RK. A Study of Opportunistic Infection in HIV-Seropositive Patients. Indian Journal of Community Medicine
  15. Panday S, Singh SP. Clinical Profile and Opportunistic Infection in HIV /AIDS Patients attending S.S.Hospital,Varanasi. Indian J Prev Soc Med 2008;39:1,I2
  16. NACO, Ministry of Health and Family Welfare Government of India. Guidelines for Prevention and Management of Common Opportunistic Infections/ Malignancies among HIV-infected Adult and adolescent; May 2007.

Corresponding Author

Shruthi Kulkarni

Department of Medicine, St. John’s Medical College Hospital, Bangalore – 34

Phone no: 91 9886546210, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.