A study of profile of patients failing first line NACO recommended ART

Abstract

Background: Failure of first line NACO recommended Therapy has been reported in 1-5% cases of HIV/AIDS. Various factors are associated with failure. This study describes the profile of patients failing first line ART (FLA) in a predominately lower socioeconomic population. The objective of the present study was to identify factors associated with failure of FLA. Methods: Retrospective data analysis of patients failing first line therapy. Epidemiological information, clinical parameters and laboratory reports were taken into consideration. Data was analysed as per standard statistical analysis. Results: Out of a total 3926 patients on first line ART for varying periods of time from our ART centre 54 patients were on second line ART. Males (2.20%) had a high failure rate than females (0.50%). The average time of failure was 64.11 months with a median of 56.50 months. 74.1% (40/54) of the patients had very low CD4 count at the time of initial diagnosis. Failure rate of FLA was higher in the patients having Stavudine based regimen (NRTI) (6.61%) and 3.64% in patients having Nevirapine based regimen (NNRTI). Conclusions: Second line therapy is required only in a small number of patients at present, but as it is related to the duration on first line ART and also with initial low CD4 count, more and more patients will require SLA in the near future.Keywords: FLA (first line antiretroviral), NNRTI (non-nucleoside reverse transcriptase inhibitor), NRTI (nucleoside/nucleotide reverse transcriptase inhibitors), SLA (second line antiretroviral), VL (viral load)

Clinical and Immunological Profiles of HIV/AIDS Patients With First-Line Antiretroviral Treatment Failure Attending a Tertiary Care Hospital

“…Among the first-line ART failure patients (immunological and clinical), maximum failure was seen in the duration of 24-30 months, with a median time of failure of 37 months. With the early and prompt diagnosis per NACO operational guidelines, the median time of switching to the second line has been delayed as observed in the present study, which agrees with another Indian study [ 25 ]. Also, with the increasing focus on the enhanced adherence counseling (EAC) and the choice of well-designed ARV regimens, the median time of first-line ART failure has improved.…”

“…As the use of a PI-based regimen as first-line HAART is limited to exceptional circumstances as per NACO guidelines and infection with HIV-2 has been excluded from the present study, any case of treatment failure with a PI-based regimen could not be identified. Several studies have reported more failure in patients on stavudine and zidovudine-based NRTI regimens than tenofovir-based regimens, whereas NNRTIs mainly reported treatment failures among patients on nevirapine-based regimens in those studies [ 2 , 16 , 25 ]. In the present study, there were no patients on a stavudine-based regimen.…”