Clinical, Immunological and Virological Profile of Patients with HIV Infection on Second Line Antiretroviral Therapy

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Background and Objectives: The goal of antiretroviral therapy is to maximally and durably inhibit viral replication. Objectives of this study were –  To study the various clinical features of patients on second line anti retroviral therapy.  To study the immunological and virological profile of these patients.  To study various factors determining the initiation of second line ART Material and Methodology: Retrospective analysis of 30 HIV patients on second line Antiretroviral Therapy was done. Clinical examination and various immunological profiles like CD4 count, CD8 count and virological profiles like viral load and viral resistance testing were noted if done. Details of therapy in terms of drugs, schedule, adverse effects etc. were noted. Results: Majority of patients had BMI in the normal range. Mean CD4 cell count increased from 114/mm3 at start of first line therapy to 168/mm3 at start of second line therapy. Immunological failure was the reason to switch to second line therapy in 63.33% patients. The most common second line regimen followed was Tenofovir + Abacavir + Lopinavir + Ritonavir, in 73.33% of patients, but it showed a high incidence of minor adverse effects. Viral load was estimated in 50% patients of which 36.67% patients had >20,000 HIV virus copies/ml. Tuberculosis was the main opportunistic infection encountered. Analysis and Discussion: Second line antiretroviral therapy has changed the prognosis of HIV infected patients who have first line regimen failure. The switch to second line treatment was relatively slow, due to CD4 cell count being used as the main criteria to switch therapy. This study highlights the importance of assessing viral load to monitor any early virological failure of first line ART to switch early to second line therapy. The