Main Article Content
Abstract
Background
The advent of HAART has decreased the progression to AIDS and AIDS related mortality and prolonged the survival .On the other hand, advances in the antiretroviral therapy have increased life span of HIV positive patients significantly. However, increased duration of antiretroviral treatment in such treatment-experienced patients is associated with the problems of adverse drug reactions (ADRs), drug interactions and emergence of drug resistant strains of HIV.
Aims and objectives
To assess the therapeutic response of second line ART regimen consisting of tenofovir + lamivudine + atazanavir and ritonavir by CD4 count and plasma viral load in HIV patients.
Methods
This was a longitudinal, prospective, observational study carried out in HIV positive patients attending ART centre, government general hospital, Vijayawada. Patients receiving first-line ARV drugs for at least six months were evaluated clinically, immunologically (CD4 count) and virologically (plasma viral load) for failure and started on second-line ART from November 2011 to November 2012 were included in the study.
Results
Out of 100 patients, 52 patients developed ADRs. In this 52, 34 patients had CD4+ count <250 cells/cu.mm and the remaining 18patients had CD4+ count >250 cells/cu.mm. The observed difference was statistically significant (p<0.0001). The plasma viral load after six months of therapy were decreased compared to the initial mean values.
Conclusion
The ADRs were most common in those patients whose CD4+ count is <250 cells/cu.mm. Early treatment outcome with second line ART in terms of immunological improvement and viral suppression was good in treatment experienced patients. Though atazanavir containing regimen is more efficacious but produces more serious adverse effects.
Background
The advent of HAART has decreased the progression to AIDS and AIDS related mortality and prolonged the survival .On the other hand, advances in the antiretroviral therapy have increased life span of HIV positive patients significantly. However, increased duration of antiretroviral treatment in such treatment-experienced patients is associated with the problems of adverse drug reactions (ADRs), drug interactions and emergence of drug resistant strains of HIV.
Aims and objectives
To assess the therapeutic response of second line ART regimen consisting of tenofovir + lamivudine + atazanavir and ritonavir by CD4 count and plasma viral load in HIV patients.
Methods
This was a longitudinal, prospective, observational study carried out in HIV positive patients attending ART centre, government general hospital, Vijayawada. Patients receiving first-line ARV drugs for at least six months were evaluated clinically, immunologically (CD4 count) and virologically (plasma viral load) for failure and started on second-line ART from November 2011 to November 2012 were included in the study.
Results
Out of 100 patients, 52 patients developed ADRs. In this 52, 34 patients had CD4+ count <250 cells/cu.mm and the remaining 18patients had CD4+ count >250 cells/cu.mm. The observed difference was statistically significant (p<0.0001). The plasma viral load after six months of therapy were decreased compared to the initial mean values.
Conclusion
The ADRs were most common in those patients whose CD4+ count is <250 cells/cu.mm. Early treatment outcome with second line ART in terms of immunological improvement and viral suppression was good in treatment experienced patients. Though atazanavir containing regimen is more efficacious but produces more serious adverse effects.
Keywords
Article Details
References
- [1]. History of HIV & AIDS in UK 1996 onwards. Available from: http://www.avert.org/ukaids.htm [Accessed 2012].
- [2]. Anthony S Fauci, H.Engene Braunwald, Dennis L.Kasper, Stephen L, Hanser, Dan, L Longo, J.Lammy Jamson, Joseph Loscalzo, H.Chifford lane. “Human Immunodeficinecy virus disease: AIDS and related disorders”- Harrisons Principles of Internal Medicine, Chapter 17(182), 1137-1203.
- [3]. Desai M et al., 2012. ‘Advances in antiretroviral drugs.’ Indian Journal of Pharmacology, 44(3), 2012, 288-98.
- [4]. Saag MS, Holodniy M, Kuritzkes DR, et al. HIV viral load markers in clinical practice. Nat Med 2(6), 1996, 625-9.
- [5]. Beuningen R et al. ‘Development of a high throughput detection system for HIV-1 using real-time NASBA based on molecular beacons.’ The International Society of Optical Engineering, 4264.
- [6]. AIDS education and training centres 2012. ‘CD4 and viral load monitoring.’Available from: http://www.aidsetc.org/aidsetc?page=cg-206_cd4_monitoring [Accessed 2012].
- [7]. National guidelines on second-line and alternative first-line ART for adults and adolescents. The National AIDS Control organisation2013, 1-105.
- [8]. NACO, 2011. ‘National guidelines on second line ART.’ Ministry of health and family welfare. Government of India.
- [9]. NACO annual report 2010-11. Available from: http://www.nacoonline.org/Quick_Links/ Directory_of_HIV_Data/ [Accessed 2012].
- [10]. Pujades-Rodrı´guez M et al., 2008. ‘Second-line antiretroviral therapy in resource-limited settings: the experience of Me´decins Sans Frontie`res.’ AIDS, 22(11), 2008, 1305–1312.
- [11]. Guha SK et al., 2011. ‘Effectiveness of addition of zidovudine to second line antiretroviral regimen of tenofovir, lamivudine and lopinavir/ritonavir in patients failing thymidine analogue based first line antiretroviral therapy in India.’ Available from: pag.ias2011.org/Abstracts.aspx?AID=3419 [Accessed on 2012].
- [12]. Castelnuovo B, John L, Lutwama F, et al. Three-year outcome data of second-line antiretroviral therapy in ugandan adults: good virological response but high rate of toxicity. J Int Assoc Physicians AIDS Care (Chic) 8(1), 2009, 52–9.
- [13]. Stephen A. Harrison, 2010.” Management of Anemia in Patients Receiving Protease Inhibitors”. J. Gastroenterol Hepatol (N Y). 8(4), 2012, 254–256.
- [14]. Sotirios T et al, 2000. “Effects of protease inhibitors on hyperglycemia, hyperlipidemia and lipodystrophy”. Arch Intern Med.160, 2000, 2050- 2056.
- [15]. Robert L. Murphy et al.. “Dose-ranging, randomized, clinical trial of atazanavir with lamivudine and stavudine in antiretroviral-naïve subjects”. AIDS 17, 2003, 2603–2614.
- [16]. Gerard L et al, 2007. Renal functions in antiretroviral experienced patients treated with tenofovir disoproxil fumarate associated with atazanavir/ritonovir. Antiviral therapy.12, 2007, 31-39.
References
[1]. History of HIV & AIDS in UK 1996 onwards. Available from: http://www.avert.org/ukaids.htm [Accessed 2012].
[2]. Anthony S Fauci, H.Engene Braunwald, Dennis L.Kasper, Stephen L, Hanser, Dan, L Longo, J.Lammy Jamson, Joseph Loscalzo, H.Chifford lane. “Human Immunodeficinecy virus disease: AIDS and related disorders”- Harrisons Principles of Internal Medicine, Chapter 17(182), 1137-1203.
[3]. Desai M et al., 2012. ‘Advances in antiretroviral drugs.’ Indian Journal of Pharmacology, 44(3), 2012, 288-98.
[4]. Saag MS, Holodniy M, Kuritzkes DR, et al. HIV viral load markers in clinical practice. Nat Med 2(6), 1996, 625-9.
[5]. Beuningen R et al. ‘Development of a high throughput detection system for HIV-1 using real-time NASBA based on molecular beacons.’ The International Society of Optical Engineering, 4264.
[6]. AIDS education and training centres 2012. ‘CD4 and viral load monitoring.’Available from: http://www.aidsetc.org/aidsetc?page=cg-206_cd4_monitoring [Accessed 2012].
[7]. National guidelines on second-line and alternative first-line ART for adults and adolescents. The National AIDS Control organisation2013, 1-105.
[8]. NACO, 2011. ‘National guidelines on second line ART.’ Ministry of health and family welfare. Government of India.
[9]. NACO annual report 2010-11. Available from: http://www.nacoonline.org/Quick_Links/ Directory_of_HIV_Data/ [Accessed 2012].
[10]. Pujades-Rodrı´guez M et al., 2008. ‘Second-line antiretroviral therapy in resource-limited settings: the experience of Me´decins Sans Frontie`res.’ AIDS, 22(11), 2008, 1305–1312.
[11]. Guha SK et al., 2011. ‘Effectiveness of addition of zidovudine to second line antiretroviral regimen of tenofovir, lamivudine and lopinavir/ritonavir in patients failing thymidine analogue based first line antiretroviral therapy in India.’ Available from: pag.ias2011.org/Abstracts.aspx?AID=3419 [Accessed on 2012].
[12]. Castelnuovo B, John L, Lutwama F, et al. Three-year outcome data of second-line antiretroviral therapy in ugandan adults: good virological response but high rate of toxicity. J Int Assoc Physicians AIDS Care (Chic) 8(1), 2009, 52–9.
[13]. Stephen A. Harrison, 2010.” Management of Anemia in Patients Receiving Protease Inhibitors”. J. Gastroenterol Hepatol (N Y). 8(4), 2012, 254–256.
[14]. Sotirios T et al, 2000. “Effects of protease inhibitors on hyperglycemia, hyperlipidemia and lipodystrophy”. Arch Intern Med.160, 2000, 2050- 2056.
[15]. Robert L. Murphy et al.. “Dose-ranging, randomized, clinical trial of atazanavir with lamivudine and stavudine in antiretroviral-naïve subjects”. AIDS 17, 2003, 2603–2614.
[16]. Gerard L et al, 2007. Renal functions in antiretroviral experienced patients treated with tenofovir disoproxil fumarate associated with atazanavir/ritonovir. Antiviral therapy.12, 2007, 31-39.