Abstract
Background: AIDS can be called our modern pandemic, affecting both industrialized and developing countries. Globally education, counselling and behaviour modification are the cornerstones of an HIV prevention strategy. There has been dramatic decline in AIDS-related morbidity & mortality with introduction of Highly Active Anti-Retroviral Therapy (HAART). To address problems of high cost, need for lifelong therapy, poor compliance, lack of awareness, social stigma and occurrence of adverse effects proper monitoring and evaluation should be undertaken for successful implementation of ART programme.
Objectives: Present study was taken up to assess efficacy of NACO-recommended HAART regimen in antiretroviral therapy naïve subjects with HIV infection.
Material & Methods: 120 properly selected subjects with confirmed HIV infection being newly started on ART were recruited as study subjects. HAART, consisting of two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitor, was instituted. The initial therapy in majority of subjects was zidovudine (AZT)+lamivudine (3TC)+nevirapine (NVP). AZT was substituted by tenofovir disoproxil (TDF) in patients with Hb< 9 gm%, whereas NVP was substituted by efavirenz (EFV) in the event of non-availability, adverse effects, or possible interactions. Subjects were monitored at regular intervals for 24 weeks. Efficacy was assessed by response based on CD4 count, TLC count, weight gain, and improvement in functional status, WHO clinical stage and general health.
Results: Majority of subjects showed good clinical improvement with increase in CD4 count. ART showed good tolerability with mild and tolerable side effects. Death occurred only in 2.5%subjects.
Keywords: Acquired immunodeficiency syndrome (AIDS), human immunodeficiency virus (HIV), highly active antiretroviral therapy (HAART), naïve, efficacy.
References
- Sweetman SC, editor. Martindale: The Complete Drug Reference. 37th Lon-don: Pharmaceutical Press;2011.938-1053.
- National AIDS Control Organization, Ministry of Health & Family Welfare. Annual report 2014-15. March 2015 (cited 18 Dec 2015). Available from: http://www.naco.gov.in/sites/default/files/annual_report%20_NACO_2014-15_0.pdf
- Wilkins EGL. HIV infection and AIDS. In: Colledge NR, Walker BR, Ralston SH, editors. Davidson’s principles and practice of medicine. 21st ed. USA: Churchill Livingstone: Elsevier Publishers; 2011.386-407.
- National AIDS Control Organization, Ministry of Health & Family Welfare. Journey of ART programme in India, Story of a decade. March 2014 (cited18 Dec 2015). Available from: http://www.naco.gov.in/sites/default/files/Journey%20of%20ART%20Programme%20in%20India%20-%20Final.pdf
- National AIDS Control Organization, Ministry of Health & Family Welfare. Antiretroviral therapy guidelines for HIV-infected adults and adolescents. May 2013. (cited on 18 Dec 2015). Available from: http://www.naco.gov.in/sites/default/files/Antiretroviral%20Therapy%20Guidelines%20for%20HIV-Infected%20Adults%20and%20Adolescents%20May%202013%281%29_0.pdf
- Kumaraswamy G, Thimmegowda N, Purushottam PH, Ramaiah V, Ramesh J, Lingegowda RK. A prospective study of highly active antiretroviral therapy in a tertiary-care hospital in south India Int J Med Sci Public Health 2015;4:35-41.
- Agarwal D, Chakravarty J, Chaube L, Rai M, Agarwal NR, Sundar S. High incidence of zidovudine induced anaemia in HIV infected patients in eastern India. Indian J Med Res 2010;132:386-9.
- Rosen S, Larson B, Brennan A, Long L, Fox M, Mongwenyana C, et al. Economic Outcomes of Patients Receiving Antiretroviral Therapy for HIV/AIDS in South Africa Are Sustained through Three Years on treatment. PLoS ONE 2010; 5(9): e12731.
- Thejus TJ, Jeeja MC, Jayakrishnan T. The Functional Status of Patients with AIDS Attending Antiretroviral Treatment Center. Indian Journal of Palliative Care 2009 Jan-June;15(1):57-60.
- Olawumi HO, Olatunji PO, Salami AK, Odeigah L, Iseniyi JO. Effect of Highly Active Antiretroviral therapy on CD4 count and weight in AIDS patient seen at the UITH, Ilorin. Niger J Clin Pract 2008 December;11(4):312-5.
- Waters L, Fisher M, Anderson J, Wood C, Delpech V, Hill T, et al. Responses to Highly Active Antiretroviral therapy and clinical events in patients with a low CD4 cell count. HIV Medicine 2011;12(5):289-98.
- Siegfried N, Uthman OA, Rutherford GW. Optimal time for initiation of antiretroviral therapy in asymptomatic, HIV-infected, treatment-naïve adults. Cochrane Database Syst Rev 2010;(3):CD008272.
- Getahun A, Tansuphasawadikul S, Desakorn V, Dhitavat J, Pitisuttithum P. Efficacy and Safety of Generic Fixed-Dose Combination of Stavudine, Lamivudine and Nevirapine (GPO-vir) in Advanced HIV Infection. J Med Assoc Thai 2006;89(9):1472-78.
- Nadkar MY, Bajpai S. Antiretroviral Therapy: Toxicity and Adherence. JAPI 2009; 57: 375-6.
- Severe P, Leger P, Charles M. Antiretroviral therapy in a thousandpatients with AIDS AIDS in Haiti. N Engl J Med 2005;353:2325-34.
- Singh H, Kachhap VK, Kumar BN, Nayak K. Nevirapine inducedStevens- Johnson syndrome in an HIV infected patient. IJP 2011;43(1):84-6.
- Rather ZA, Chowta MN, Prakash Raju GJ, Mubeen F. Evaluation of theadverse reactions of antiretroviral drug regimens in a tertiary carehospital. Indian J Pharmacol 2013;45:145-8.
- Mir MA, Ahmad PM, Siddeque MA, Sofi FA, Ahmad SN, Dar MR. Clinical and demographic profile of HIV/AIDS patients diagnosed at a tertiary care centre in Kashmir. J Pak Med Assoc 2010; 60(No.6):428-31.
- Ghate M, Deshpande S, Tripathy S, Nene M, Gedam P, Godbole S, et al. Incidence of common opportunistic infections in HIV-infected individuals in Pune, India: analysis by stages of immunosuppression represented by CD4 counts. International Journal of Infectious Diseases 2009;13:e1-e8.
- Seddon J, Bhagani S. Antimicrobial therapy for the treatment of opportunistic infections in HIV/AIDS patients: a critical appraisal. HIV/AIDS - Research and Palliative Care 2011;3:19–33.
Corresponding Author
Dr Rajat Chhabra
Assistant Professor, Department of Pharmacology, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra
Phone no - +91 7972153228, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.