Document Detail


Predictors of failure of first-line antiretroviral therapy in HIV-infected adults: Indian experience.
MedLine Citation:
PMID:  17620752     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To study the incidence and risk factors for failure of treatment with antiretroviral therapy among adults in the national treatment program in India, and to estimate the possible number of persons living with human immunodeficiency virus (HIV) who will need a second-line treatment regimen in the next 3 and 3.5 years. DESIGN AND SETTING: Data of a cohort of HIV-positive adult patients, who were enrolled in the government-sponsored antiretroviral therapy program, were obtained from the electronic medical record system of the largest HIV care center in India and subjected to analysis. MAIN OUTCOMES: Treatment failure defined by the World Health Organization criteria, assessed immunologically on the basis of CD4 T cell count, with a minimum period of 12 months of follow-up and with a minimum of two CD4 T cell follow-up measures. RESULTS: The cumulative incidence of treatment failure in the 1370 adult patients included in the study was 3.9% (95% confidence interval [CI] 2.9 to 4.9). Men had a 3.5 (1.6 to 7.4) times significantly greater risk of treatment failure. Patients who had negative changes in absolute lymphocyte count, hemoglobin concentration and body weight had 3.1 (1.6 to 6.2), 3.2 (1.6 to 6.2), and 3.5 (1.9 to 6.4) times significantly greater risk of treatment failure. In India, after 2007, by 2, 3, and 3.5 years, respectively, an estimated 16 000, 35 000, and 51 000 patients receiving antiretroviral therapy are likely to require second-line treatment. CONCLUSION: Monitoring of hemoglobin concentration, absolute lymphocyte count, and body weight during follow-up emerged as inexpensive predictors of treatment failure in a resource-poor setting. A significant number of patients will need second-line therapy as a result of failure of their first-line antiretroviral therapy regimen in 3 and 3.5 years in India, and therefore the development of an appropriate policy for second-line drugs is urgently needed.
Authors:
Sikhamani Rajasekaran; Lakshmanan Jeyaseelan; Sundaraj Vijila; Chandrahasan Gomathi; Krishnaraj Raja
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  AIDS (London, England)     Volume:  21 Suppl 4     ISSN:  0269-9370     ISO Abbreviation:  AIDS     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-07-10     Completed Date:  2007-10-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  England    
Other Details:
Languages:  eng     Pagination:  S47-53     Citation Subset:  IM; X    
Affiliation:
Government Hospital of Thoracic Medicine, Tambaram Sanatorium, Chennai-600047, India. rajasekaran.s@ghtm.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anti-HIV Agents / therapeutic use*
Antiretroviral Therapy, Highly Active / methods
Body Weight
CD4 Lymphocyte Count
Epidemiologic Methods
Female
Government Programs
HIV Infections / blood,  drug therapy*,  immunology
Hemoglobins / analysis
Humans
India
Lymphocyte Count
Male
Middle Aged
Patient Compliance
Prognosis
Sex Factors
Treatment Failure
Chemical
Reg. No./Substance:
0/Anti-HIV Agents; 0/Hemoglobins

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