
A Retrospective Analysis of Plasma Viral Load in Cases of Immunological Failure in HIV Patients on HAART from Central India: How Close are We to the 90-90-90 Target?
DC05-DC09
Correspondence
Dr. Meena Mishra,
S-01, Shri Sunder Apts, Rajabaxa Road, Wanjari Nagar, Opp. TB Ward, Nagpur-440003, Maharashtra, India.
E-mail: meenarishika@yahoo.co.in
Introduction: Anti-Retroviral Therapy (ART) initiation in patients leads to increase in CD4 counts and decrease in the Plasma Viral Load (PVL). However, some patients fail to achieve a significant increase in CD4 count despite undetectable PVL. In spite of complete viral suppression, patients have immunological failure; this is referred as “immunological discordance”. This study is a retrospective analysis of PVL in cases of immunological failure in Human Immunodeficiency Virus (HIV) patients and aims to find out the rate of discordance and associated co-morbid conditions.
Aim: To carry out a retrospective analysis of PVL in HIV patients with immunological failure on ART in a tertiary health care centre in Nagpur, Maharashtra, India.
Materials and Methods: This study was carried out at the ART centre in Government Medical College and Hospital, Nagpur, Maharashtra, India. Patients (>16 years of age) of immunological failure (458) who started second-line ART during the period 2012-2017 were included in the study. The data was coded using MS-Excel 2013 and statistical softwares OpenEpi (Version 3.01) and STATA (Version 10.1-2011, Texas, USA) were used for analysis.
Results: The most common co-existing condition seen was tuberculosis. Risk of low (<100) baseline CD4 count was almost three times higher in males. Risk of immunological failure {in those with greater than 100 cell decrease after six months of Highly Active Antiretroviral Therapy (HAART)} was higher in those with low baseline CD4 counts (0-200 cells/mm3) (OR-1.39). The rate of discordance was 17.82%. The number of patients of immunological failure decreased when ART was initiated at higher CD4 counts.
Conclusion: Discordance was seen in patients of immunological failure, thus, PVL assay must be done before second line ART initiation to avoid unnecessary switching of regimen. Early initiation of ART can lead to a better prognosis, thus helping us reach closer to the 90-90-90 target.