Ajith, Sivadasan (2007) Incidence and determinants of failure of the initial Highly Active Antiretroviral Therapy (HAART) regimen in a cohort of art naïve HIV infected South Indian Adults. Masters thesis, Christian Medical College, Vellore.
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Abstract
OBJECTIVES OF THE STUDY : To determine the incidence and predictors of failure of the initial HAART regimen in a cohort of ART-naïve, HIV-infected south Indian adults. METHODS : A cohort of ART-naïve HIV-infected south Indian adults who were initiated on HAART (as per WHO and NACO guidelines) after March 1, 2004 were prospectively followed up. “Failure” was defined as any event requiring either discontinuation or change in the initial HAART regimen. This included virological, immunological or clinical failure, serious ADR, non-adherence and death. A logistic regression analysis was performed to determine the factors associated with HAART failure. RESULTS : Two hundred and thirty subjects were enrolled during the 27 months from March 1, 2004 to May 31, 2006. The median age was 37 years (IQR, 34-44) and 74.8% of the subjects were males. Majority (70.4%) had advanced HIV infection (WHO clinical stage III/IV) and 79% had CD4 counts below 200 cells/μL. Stavudine-based regimen was used in 76% and 86% were on a NVP-based regimen. During the median follow-up of 48 weeks, 91 (39.6%) patients experienced failure. The main reasons for failure were ADR (68.1%), non-adherence (20.9%) and clinical failure (7.7%). The most common ADR were attributable to the thymidine analogue NRTIs - d4T induced symptomatic hyperlactatemia (8.7%), peripheral neuropathy (5.2%), and AZT induced anemia (7%). The mortality (4.6/100 person-years) and disease progression rates (4.1/100 person-years) were low. Advanced HIV infection (OR 1.59), smoking (OR 2.16), BMI > 25 kg/sq.m (OR 1.56), deranged liver enzymes (ALT > 40U/L - OR 2.25, AST > 40U/L - OR 4.07) and longer duration of illness (OR 1.224) were associated with HAART failure. CONCLUSION : HAART regimens used in this study, though effective in decreasing the rates of disease progression and death, were associated with high rates of ADR, particularly those attributable to thymidine analogue NRTI. Improving access, earlier initiation, careful screening at baseline and better tolerated drug regimens could potentially improve the outcome of these patients.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Incidence ; determinants ; failure ; initial ; Highly Active Antiretroviral Therapy (HAART) ; regimen ; cohort of art naïve HIV infected ; South Indian Adults. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 15 Feb 2018 17:22 |
| Last Modified: | 15 Feb 2018 17:22 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5715 |
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