Clinical Profile and Response to First-Line Anti-Retroviral Therapy in Human Immunodeficiency Virus Infected Patients in Manipur

Abstract

<strong>Background:</strong>Knowledge of demographic profiles and baseline characteristics of HIV infected patients is essential for devising prevention strategies. Analysis of factors influencing improvement in CD4 cell count will help to determine prognosis and better implementation of ART.<p><strong>Objectives:</strong> This retrospective study was conducted on HIV patients in Manipur, to assess clinical profile and factors influencing baseline immunological status and response to ART.</p><p><strong>Methodology:</strong> 1231 patients were enrolled. Baseline demographic and laboratory parameters were recorded. CD4 cell counts were recorded at baseline and 6 months after ART initiation.</p><p><strong>Results:</strong> 66.3% patients were male, 74.6% aged 21-40 years, 65.6% were Hindus and 52.9% of urban residence. 17.5% patients had Haemoglobin ≤9 grams/dl. Prevalence of HIV-HBV and HIV-HCV coinfection was 3.4% and 20.5% respectively. Male sex (141.51±96.21 vs. 169.92±111.2 cells/mm<sup>3</sup>; p=0.001), age >20 years and Haemoglobin ≤9 g/dl (127.5±99.5 vs. 153.8±99.1cells/mm<sup>3</sup>; p=0.001) were associated with lower baseline CD4 count. Females (219.01±187.2 vs. 161.79±153.35cells/mm<sup>3</sup>; p=0.001), age group 1-20 years and those without HIV-HCV coinfections (188.72±170.81 vs. 154.20±155.88 cells/mm<sup>3</sup>; p=0.004) had significant improvement in CD4 count at 6 months-post ART initiation. CD4 response in HIV-HBV coinfected patients was lower (188.59±170.65 vs. 162.39±139.8 cells/mm<sup>3</sup>; p=0.324) but not statistically significant.</p><p><strong>Conclusion:</strong> Majority of HIV patients in Manipur were - Males, Hindus, aged 21-40 years and of urban residence. Males, age >20 years and haemoglobin ≤9 g/dl were associated with lower baseline CD4 count. HIVHBV/ HIV-HCV coinfection wasn't associated with lower baseline CD4 count. Females, age <20 years and absence of HIV-HBV/HIV-HCV coinfections were associated with superior immunological response to ART.</p>

Cluster of differentiation 4+ T-cell counts and human immunodeficiency virus-1 viral load in patients coinfected with hepatitis B virus and hepatitis C virus

“…HIV promotes hepatic fibrogenesis by production of reactive oxygen by hepatocytes through a Kappa-dependent pathway, this effect is enhanced in the presence of HCV. [ 25 ] Recent studies from Manipur, India,[ 6 ] Asia,[ 26 ] Switzerland,[ 27 ] and Australia[ 28 ] have postulated that patients coinfected with HIV/HBV/HCV appear to have a poorer response to HAART in terms of CD4+ T-cell count changes. A Chinese study also inferred similar results in HIV/HBV coinfected individuals at 48 months post-ART both in terms of CD4+ T-cell count and HIV-1 RNA suppression.…”

“…Many studies from India and around the world have reported that HBV/HCV coinfection did not affect CD4+ T-cell counts and HIV-1 viral load suppression after ART. [ 5 6 7 9 ] It has been hypothesized that splenic sequestration of lymphocytes due to HBV-related hepatic fibrosis may be responsible for lower CD4+ T-cell recovery. [ 30 ] Many underlying comorbid conditions, other OIs, small sample size, and lack of compliance/adherence may affect these results.…”

“…Although various authors have evaluated the short-term response to ART on HIV/HBV and HIV/HCV coinfected individuals, the impact of HBV and HCV on HIV treatment outcomes is not clear due to variable reports. [ 5 6 7 8 9 ]…”