Study of Immunological and Virological Recovery in HIV/AIDS Patients on Second Line Anti-Retroviral Therapy: A Prospective Study

Abstract

AIMS/BACKGROUND: Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). Highly active antiretroviral therapy (HAART), is the cornerstone of management of patients with HIV infection. Following the initiation of widespread use of HAART, drug resistance and failure of first line ART is an emerging problem. Hence use of second line ART is on rise, therefore there is a need to study the factors affecting the immunological and virological recovery and specific opportunistic infections during second line ART. In India, the second line regimen has still not been studied extensively when compared to its first line counterpart. This study aims at determining the immunological and virological recovery as well as to study the incidence of various opportunistic infections in HIV/AIDS patients on second line ART. METHODS: The study was conducted at Bowring & Lady Curzon Hospital, affiliated to Bangalore Medical College from November 2015 to January 2019.The study included 72 patients, switched from first line to second line ART in the year 2015-16 and consented to participate in our study. Patients were analyzed in out-patient as well as in-patient basis, as per need. Clinical assessment was repeated every 6 months for next 3 years. RESULTS: In our study 42 males (58.3%) and 30 females (41.6%) were included. There was a gradual rise in CD4 count from baseline. 81.69% (59) cases had CD4 count 200 at the end of 3 years. Mortality was 5 cases (6.94 %). Among patients who expired, had baseline CD4 Count <100 cells/microliter, stage 3 and 4 at initiation of first line ART. Low CD4 nadir and opportunistic infections during first line ART and T4 stage while switching to second line ART. CONCLUSION: 1. There was a significant improvement in CD4 Counts and fall in viral load after initiation of Second line ART. 2. Severe immunosuppression (CD4 Count <100 cells/microliter) at baseline were associated with low CD4 counts recovery and delayed viral load suppression. FUNDING STATEMENT: None. DECLARATION OF INTERESTS: None. ETHICS APPROVAL STATEMENT: After obtaining ethical clearance and approval from the Institutional Ethics Committee of BMCRI, written informed consent was taken from the patients.