Abstract
BackgroundShort term efficacy of combination antiretroviral therapy (cART) in resource-constrained settings is comparable to that found in western studies. However, long term data are limited. India has the third largest HIV infected population in the world but the long-term outcome of first line therapy according to the national guidelines has not been evaluated yet. Therefore, we conducted a long-term longitudinal analysis of the efficacy of the national first-line therapy in India from an observational cohort of Indian patients in two different clinical settings.Methodology/Principal FindingsA total 323 patients who had been on ART for a median of 23 months and achieved virological suppression <100 copies/ml by their study baseline visit, were included and followed for two years. Blood samples were collected every six months for viral load and CD4 count. Drug resistance genotyping was performed when the viral load was >2000 copies/mL. Adherence and treatment interruptions (>48 h) were assessed via self-report. In the studied patients, the median duration of viral suppression was 44 months; 15.8% of patients showed viral rebound, and 2.8% viral failure. Viral rebound or failure was significantly negatively related to perfect adherence (100% adherence and no treatment interruption >48 hrs). Virological re-suppression in the subsequent visit was observed in three patients without any change in therapy despite the presence of key mutations.Conclusion/SignificanceOur study reports for the first time, a good long-term response to the first line therapy for a median of nearly four years although a less than perfect adherence increases the risk for treatment failure and subsequent drug resistance development. The empirical findings in this study also indicate the overall success of the Indian ART program in two different settings which likely are representative of other clinics that operate under the national guidelines.
Highlights
The attainment and maintenance of sustained viral suppression is the ultimate goal of antiretroviral therapy (ART)
The optimal response to therapy is the substantial decrease in viral load (VL) to below the technical specificities of the VL assays which results in the avoidance of emergence of drug resistance mutations [1]
Our results indicate a good overall long-term response to first line therapy reflecting an overall success of the standardized Indian national program for individuals with HIV infection
Summary
The attainment and maintenance of sustained viral suppression is the ultimate goal of antiretroviral therapy (ART). In resource constrained settings like sub-Saharan Africa and India, treatment efficacy is typically monitored through immunological markers such as measurement of CD4+ T cell count, [3] whereas VL monitoring is usually restricted to research settings. Despite this caveat, the short term outcomes of cART in resourceconstrained settings are comparable to those in resource-rich settings [4,5]. The data on long term outcome, are limited as most of the studies have been conducted within the first two years after initiation of ART [5]. We conducted a long-term longitudinal analysis of the efficacy of the national first-line therapy in India from an observational cohort of Indian patients in two different clinical settings
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