Therapeutic response following highly active antiretroviral therapy

Veni, A (2010) Therapeutic response following highly active antiretroviral therapy. Masters thesis, K.A.P. Viswanatham Government Medical College, Tiruchirappalli.


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INTRODUCTION : AIDS – the acquired immuno deficiency syndrome called slim disease is a fatal illness caused by a retrovirus known as human immuno deficiency virus which breakdown the body’s immune system leaving the victim Vulnerable to a host of life threatening opportunistic infections, neurological disorders or unusual malignancy. Strictly speaking the term AIDS refers only to the last stage of the HIV infection. The human immunodeficiency virus (HIV) infection has spread worldwide, with various adverse health and economic implications, particularly in the developing world. Unless a cure is found or life prolonging therapy can be made more widely available, the majority of people will remain suffering the profound impacts the disease has on their quality of life. Globally, 33 million people were estimated to be living with HIV/AIDS in 2007. The number of HIV-positive TB cases and deaths were estimated at 1.39 million cases (15% of all incident cases) and 0.48 million deaths, which was 24% of the estimated two million HIV deaths in 2007. In India, the 2006 estimates suggested that national adult HIV prevalence in India was approximately 0.36 per cent, amounting to 2.34 million (ranging between 2 and 3.1 million) people living with HIV and AIDS. Even going by the conventional figure of 40% of the Indian population infected with Mycobacterium tuberculosis, it is estimated that not less than one million persons with HIV are co-infected with TB. Considering the fact that the lifetime risk of developing TB disease is between 50-60%, India is likely to have not less than one lakh patients, needing treatment for both HIV and TB simultaneously at any given point of time. Free Anti-Retroviral Therapy (ART) was introduced in India in April, 2004, as a component of care, support and treatment, in National AIDS Control Program(NACP). The concept of managing HIV disease in India till that time was to treat the opportunistic infections, as and when these were identified. Initiation of ART reduces risk of further HIV-related morbidity and mortality. ART reduces the incidence of TB even in high TB prevalence countries. AIM OF THE STUDY : 1. To study the clinical response to highly active antiretroviral therapy (HAART). 2. To study the Immunological response to highly active antiretroviral therapy (HAART). 3. To study the functional status improvement to highly active antiretroviral therapy (HAART). 4. To study the prevalence of HIV and TB co-infection. MATERIALS AND METHODS : The study was conducted on 118 HIV infected adults who attended the ART centre, Annal Gandhi Memorial Hospital from August 2007 to August 2009. All patients were thoroughly evaluated by detailed history, general examination, systemic examination, appropriate Investigations as per proforma. List of Pre and Post treatment investigation included the following. 1. Hemoglobin, 2. Total and differential count, 3. Erythrocyte Sedimentation Rate, 4. Platelet count, 5. Blood sugar, 6. Blood urea, 7. Serum creatinine, 8. Liver function test, 9. X-Ray chest PA view (If necessary), 10. Sputum for AFB (If necessary), 11. CD4 count (6 monthly), 12. Other specific test it needed. Selection Criteria : The following criteria are used for selection of HIV patients: 1. Patient should be more than or equal to 20 years. 2. The diagnosis of HIV confirmed as per WHO criteria. 3. Initiation of HAART according to WHO criteria. Exclusion criteria : 1. Patient less than 20 years. 2. The patients who have already received treatment with ART outside. 3. Patients who died within 6 months after initiation of HAART. 4. Patients who missed more than 12 doses per month. 5. Patients who lost follow up after initiation of HAART. CONCLUSION : 1. Majority of HIV patients belongs to reproductive age group. 2. Institution of HAART was associated with weight gain and decrease in opportunistic infection. 3. A high rate of immunological response was observed following HAART. 4. The Immunological and clinical response to HAART in HIV infected Tuberculosis patients were similar to those of Non-Tuberculosis patients. 5. Institution of HAART was associated with functional status improvement and mental well being. 6. 32%of patients had HIV and Tuberculosis as a coinfection. In which 21% having pulmonary Tuberculosis, 11%having extrapulmonary Tuberculosis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Therapeutic response ; highly active ; antiretroviral therapy.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 13 Feb 2018 15:35
Last Modified: 13 Feb 2018 15:35

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