INCIDENCE OF SWITCHING TO SECOND LINE TREATMENT AMONG HIV PATIENTS RECEIVING ANTI-RETROVIRAL THERAPY
Aim: The main aim of this study is to estimate the incidence of switching to second line Anti-Retroviral Therapy (ART) among HIV patients.
Objective: The primary objective of this study is to determine the reason for switching to second line ART. The secondary objective of the study is to estimate the rate of treatment failure among HIV patients receiving first line ART. To determine the factors responsible for first line treatment failure.
Methodology: A Retrospective Observational study is conducted at a tertiary care hospital, Ongole, Prakasam District, Andhra Pradesh. Incidence of switching to second line ART among 4,187 HIV patients is assessed.
Results: In our study, we have collected ART cards of 4,187 patients living with HIV/AIDS. Out of which 3,419 patients are excluded from the study. 768 patients are included for the study who met the inclusion criteria. Of these patients, 739 members are receiving first line regimen and 29 patients are switched to second line Anti-Retroviral Therapy (3.77%).
Conclusion: Our study concluded a low incidence of switching to second line ART with an incidence rate of 1.01 per 100 persons a year. Out of 29 patients, failure of first line treatment is majorly observed with AZT+3TC+NVP (Zidovudine+Lamivudine+Nevirapine) among 13 patients (44.82%). Reasons for failure are determined majorly as a result of immunological and virological failure (37.93%). These reasons are associated with decreased adherence of 80-90% among 21 patients (72.41%).
2. National AIDS Control Organization (NACO). National Technical Guidelines on Antiretroviral Treatment [internet]. India: NACO; cited on: 25 October, 2018. Available from: https://lms.naco.gov.in/frontend/pdf
3. World Health Organization report, HIV/AIDS, 19 July, 2018, World Health Organization (WHO). HIV/AIDS fact sheets [internet]. Geneva: WHO; cited on: 19 July, 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids
4. Joseph T. Dipiro, Robert L. Talbert, Gary C. Yee, Gary R. Wells, L. Michael Posey. Pharmacotherapy, a Pathophysiologic Approach. 7th edition. Mc Graw Hill Medical; 2008: 2066-2067.
5. World Health Organization (WHO). WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Geneva: WHO; cited on: 07 August, 2006. Available on: https://www.who.int/hiv/pub/vct/hivstaging/en/
6. V Nissapatorn, C.K.C.Lee, Y.A.L.Lim, K.S.Tan, I.Jamaiah, M.Rohela et al., Toxoplasmosis: A Silent Opportunistic Disease in HIV/AIDS patients. Research Journal of Parasitilogy. 2007; 2(1):23-31.
7. U. S. Department of Health and Human Services. HIV and Oppurtunistic Infections, Coinfections, and Conditions [internet]. U. S. National Library of Medicine; cited on: 15 June, 2018.
8. Roger Walker and Cate Whittlesea. Clinical Pharmacy and Therapeutics. 5th edition. Edinburgh. Churchill Livingstone; 2012: 624-625.
9. Joseph T. Dipiro, Robert L. Talbert, Gary C. Yee, Gary R. Wells, L. Michael Posey. Pharmacotherapy, A Pathophysiologic Approach. 7th edition. Mc Graw Hill Medical; 2008: 2067.
10. Roger Walker and Cate Whittlesea. Clinical Pharmacy and Therapeutics. 5th edition. Edinburgh. Churchill Livingstone; 2012: 627-637.
11. Jigarp.Modi, Amitakubavat, shaileshmundhava, UshaLalwani. A prospective study to evaluate prescription pattern of second line anti-retroviral therapy given to HIV patients. Journal of Young Pharmacists. 2018; 10(1): 117-122.
12. Grace Mc Comsey and J Lonergan. Mitochondrial Dysfunction: Patient Monitoring and Toxicity Management. Journal of Acquired Immune Deficiency Syndromes. September 2004; 37: S30-S35.
13. Andrew Carr. An objective case definition of lipodystrophy in HIV-infected adults: a case-control study. PlumX Metrics. March 2003; 361(9359):726-735.
14. Lichtenstein KA. Redefinig lipodystrophy syndrome: risks and impavct on clinical decision making. Journal of Acquired Immune Deficiency Syndromes. August 2005; 39(4):395-400.
15. Schambelan M, Benson CA, Carr A, Currier JS, Dube MP, Gerber JG et al., Management of metabolic complications associated with antiretroviral therapy for HIV-1 infection: recommendations of an International AIDS Society- USA panel. Journal of Acquired Immune Deficiency Syndromes. November 2002; 31(3): 257-275.
16. Sabin, C.A., Worm, S.W., Weber, R., et al., 2008. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet 371, 1417–1426.
17. Worm, S.W., Sabin, C., Weber, R., et al., 2010. Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti HIV drugs (D:A:D) study.The Journal of .Infectious. Diseases. 201, 318–330.
18. Parveen Kumar and Michael Clark. Clinical Medicine. 8th edition. Edinburgh. Saunders; 2012: 184-185.
19. Olivia Keiser, Catherine Orrell, Matthias Egger, Robin Wood, Martin W. G Brinkhof, Hansjakob Furrer et al., Public- Health and individual approaches to antiretroviral therapy: Township South Africa and Switzerland compared. Public Library of Science. September 2008; 5(9): e195.
20. Mar Pujades-Rodriguez, Daniel O’Brein, Pierre Humblet, Alexandra Calmy. Second-line antiretroviral therapy in resource-limited settings: the experience of Medicines Sans Frontieres. Acquired Immuno Deficiency Syndrome (AIDS). July 2008; 22(11): 1305-1312.
21. Thomas Gsponera, Maya Petersenb, Matthias Eggera,c, Sam Phirid, Marloes H. Maathuise. The Causal Effect of Switching to Second–line ART in Programmes without Access to Routine Viral Load Monitoring. National institute of health science. 2012; 26(1): 57–65.
22. Habib O. Ramadhani, John A. Bartlett, Nathan M. Thielman, Brian W. Pence, Stephen M. Kimani, Venance P. Maro et al., The Effect of Switching to Second-Line Antiretroviral Therapy on the Risk of Opportunistic Infections Among Patients Infected with Human Immunodeﬁciency Virus in Northern Tanzania. Infection Disease Society of America. 2016; 1-7.
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