Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
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ORIGINAL ARTICLE
Year : 2019  |  Volume : 40  |  Issue : 2  |  Page : 159-164

Characterization of human immunodeficiency virus-infected patients of suspected first-line antiretroviral treatment failure within 5 years – Evidence from a tertiary hospital, Kolkata


1 Department of Tropical Medicine, School of Tropical Medicine; Centre of Excellence in HIV Care, National AIDS Control Organization, Kolkata, West Bengal, India
2 Centre of Excellence in HIV Care, National AIDS Control Organization, Kolkata, West Bengal, India
3 Centre of Excellence in HIV Care, National AIDS Control Organization; Department of Medicine, SSKM Hospital and Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Correspondence Address:
Dr. Dolanchampa Modak
A/1, Park End Apartment, 4/1 Raj Kumar Chatterjee Road, Kolkata - 700 037, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijstd.IJSTD_81_18

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Objectives: Antiretroviral therapy (ART) has immense survival benefit on human immunodeficiency virus (HIV)-infected people. However, every year, a proportion of patients were failing to the first-line drugs. The aim of this study is to characterize the patients developing first-line failure within 5 years of ART. Materials and Methods: A retrospective observational study was carried out at the Centre of Excellence in HIV care, School of Tropical Medicine, Kolkata. A total of 190 referred patients' data of suspected first-line treatment failure who failed first-line ART within 5 years of initiation were collected and analyzed using R software. Results: Among 190 patients, 100 (52.4%) patients had virologic failure. Male patients 78 (41.05%) outnumbered females 22 (11.57%) and needed to switch to the second-line drugs. The median age was 37 years (range 8–65 years), and the median duration of first-line ART taken was 2.85 years. Among the first-line failed patients, zidovudine, lamivudine, and nevirapine (23.6%) was the most common antiretroviral regimen and 77 (40.5%) referred in the WHO stage I of illness. Seventy-three (38.42%) patients were referred for immunological failure, 26 (13.7%) for both immunological and clinical failure, and only 1 (0.52%) had only clinical failure at the time of referral. We found a significant association of suboptimal adherence (P < 0.05) and high viral load in this study. Conclusion: This study enables that poor adherence was the most important factor responsible for the first-line treatment failure. As adherence is a dynamic process, interventions in every visit following ART initiation should be optimized, and a multidisciplinary approach toward adherence is needed to get the highest treatment outcome benefit.


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