Background: HAART (Highly active antiretroviral therapy) is the cornerstone of management of patients with HIV infection. Antiretroviral therapy was started in the year 1986 with the first drug Zidovudine (ZDV). Later on, other antiretroviral drugs (NRTIs, NNRTIs and Pls) were introduced. Dual and mono therapies were used initially but the problem of resistance emerged. Currently, 3 or more ARV drugs are recommended globally for the treatment of people with HIV infection.Methods: A cross-sectional descriptive study conducted at a tertiary care Hospital over 200 patients, two commonly used medications are ZLN (Zidovudine+Lamivudine+Nevirapine) and TLE (Tenofovir+Lamivudine+Efavirenz ). The factors considered to affect the clinical and immunologic outcomes in both groups were assessed using baseline CD4 count, WHO clinical staging, presence of chronic diarrhea, anemia, and baseline weight, occurrence of TB, and switching of ART regimen.Results: A total of 200 patients were included in the study. ART documents of 100 patients are on Zidovudine+Lamivudine+Nevirapine) and 100 patients are on TLE (Tenofovir+Lamivudine+Efavirenz) regimen. Out of 200 patients, 97 were males and 103 were females. Maximum number of subjects were in the age of 15-45 years (82.5%) followed by 45 and above (17.5%). Mean age was 34.5±2.5 (years) with range 15 to 65 years. The baseline CD4 count of the patients, 94 were <350 and 6 were ≥350 on ZLN, in case of TLE 82 were <350 and 18 were ≥350. CD4 count after 6 months in 200 patients as follows, 60 were <350 and 40 were ≥350 in case of TLE 53 were <350 and 47 were ≥350.Conclusions: This research finding concluded that there is no critical difference between the two medications in regards to serious adverse events but did find that TDF is superior to AZT in terms of immunologic response and adherence and more frequent emergence of resistance.

In this chapter, the normal anatomy of the heart as well as pathologic cases is consistent with cardiac malposition and isomerism, septal defects, pulmonary stenosis/atresia/absent pulmonary valve syndrome, aortic malformation, hypoplastic left heart, conotruncal anomalies/common arterial trunk, tricuspid dysplasia, Ebstein anomaly, univentricular heart, and systemic venous abnormalities among other congenital cardio vascular defects by ultrasound images. Anatomical details of most CHD in fetus were provided by two-dimensional (2D) ultrasound with higher quality imaging, which enhances the diagnostic accuracy in a variety of CHD.

Background: HIV/AIDS was first recognized in USA in 1981 when centre for disease control (CDC) reported unexplained occurrence of Pneumocystis carinii pneumonia in 5 healthy homosexuals. Soon it was recognized in drug abusers and blood transfusion recipients. The present study has been taken up with an aim to know the incidence of various opportunistic infections in HIV positive patients and to correlate different opportunistic infections (OIs) with the CD4+cellcount.Methods: Sample of 132 cases admitted in Gandhi hospital during the study period were taken. CD4+ counting of blood samples was done by Flow cytometry as per manufacturer’s instructions (FACS Calibur, Becton- Dickinson, Immunocytometry system). Correlation of CD4 cell counts was done with the respective opportunistic infections.Results: TB (50%) is the most frequent OI followed by candidiasis (49%), pneumocystis (16%) and others. The mean CD4 cell count in TB was 110.80/mL and in candidiasis 97.84/mL. Low values were observed in CMV (27/mL) and in toxoplasmosis (61.66/mL).Conclusions: In most of the patient’s respiratory system was the most common system involved by OIs and had CD4 T cell count below 200/mL. Early diagnosis and prompt treatment of opportunistic infections is important. This study helps the clinicians in proper guidance to come up before development of severe immunodeficiency to prevent serious and fatal outcome.

Introduction:In India, ART service was established in 2004 and viral load facility was started in 2009 through National Public Health Laboratory (NPHL). Phased scale-up has been planned to efficiently and successfully expand viral load testing services, taking into account the targets for enrollment of People Living with HIV in to Anti Retroviral Therapy program. Methods: This is an observational study conducted at the Centre of Excellence (COE), Gandhi Hospital Secundrabad. It is a referral centre for evaluation of patients suspected of treatment failure from ART centers. Data of all patients >18 years of age who were started on second line therapy due to failure of first line ART was taken in the study. The data of patients admitted between the time period of January 2009 to January 2010 was included. Results: A total of 147 HIV infected patients received second line ART of which 114 were men and 33 were women. Of these, 147 were treated with regimen TL, ATV/r. The most common cause to switch on second line ART was combined immunological and clinical failure (135) followed by all three failure (12).Mean baseline CD4 count was 220.06 (95% confidence interval [CI]: 243. 73-196.38) and mean base line of PVL of patients was 291356.6 cells/mm 3 (95% CI: 364843.8-217869.29) copies/ml, respectively. Conclusion: Good long term outcome as well as virological suppression in patients starting second line therapy under programmatic conditions in India. This early mortality can be circumvented by introducing routine virological monitoring in the program which will help in early detection of patients with failure. Available online at: www.medresearch.in 290 | P a g e Variables and treatment outcome-An attempt was made to predict the variables associated with viral suppression. Of 147 patients 116 showed TND (Target not detected) and 6 patients were showing with viral suppression (<400 copies/ml) at 12 months. 25 patients were expired till now. It was found that poor personal habits (tobacco, smoking, and alcohol), WHO stage III/IV condition, low baseline CD4 count and high baseline PVL were associated with poor treatment outcome in terms of failure to achieve virological suppression [ Table 2].Safety assessment and adherence-A total of 25 adverse drug reactions (ADRs) were observed in during the studyperiod. The most common ADR was diarrhoea, anemia, dyslipidemia, nephro toxicity.The pill count showed that the majority of patients (94%, 95% CI: 89-97) on second line ART were adherent to the treatment with more than 95% compliance. The number of tablets to be consumed by each patient per day in regimen TL, ATV/ris 2per day respectively.

Introduction: Human immunodeficiency virus (HIV) virus, causative agent in acquired immunodeficiency syndrome, is fast becoming a major threat in the Indian subcontinent, with an estimated 3.7 million persons being infected with HIV. HIV infection is complicated by various opportunistic infections (OIs) such as tuberculosis (TB), candidiasis, herpes zoster, Pneumocystis jirvoceii, cytomegalovirus (CMV) etc. This study carried out to know the clinical profile of HIV patients who require admission. Material and methods:The aim of this study to determine the spectrum of opportunistic infections in adult AIDS patients. A total of 132 patients were tested for spectrum of opportunistic infections. All the specimens were processed as per standard procedures to detect bacterial, fungal, parasitic and viral infections.Results: Among 132 patients, 34.84% were females, 63.63%males and 1.49% were transgender males. High proportions of patients were observed in 28-37 years of agegroup and heterosexual route was the most common mode of transmission. TB (50%) is the most frequent OI followed by candidiasis (49%), pneumocystis (16%) and others. Conclusions:Respiratory system was the most common system involved by OIs. Early diagnosis and prompt treatment of opportunistic infections is important before development of severe immunodeficiency to prevent serious and fatal outcome.