Evidence for lower CD4&lt;sup&gt;&lt;b&gt;+&lt;/sup&gt;&lt;/b&gt; T cell and higher viral load in asymptomatic HIV-1 infected individuals of India: Implications for therapy initiation

Kannangai, Rajesh; Kandathil, AJ; Ebenezer, DL; Nithyanandam, G; Samuel, Prasanna; Abraham, O C; Sudarsanam, TD; Pulimood, SA; Sridharan, Gopalan

doi:10.4103/0255-0857.42031

Cited by 12 publications

(8 citation statements)

References 8 publications

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“…Contrary to this, in our study 23.70% of patients having CD4 count < 250 cells/mm 3 were asymptomatic. Similar findings have been reported by R. Kannangia et al (2008) where ten (15.2 %) of the 66 patients in CDC category C with CD4 count <200 cells/mm 3 were asymptomatic [5]. Thus Table 2.…”

Section: Discussionsupporting

confidence: 88%

“…Also, cut off values of CD4 counts for starting the patient on ART are determined based on findings in western population which may not be appropriate in our settings [7]. The new categories of CD4 counts proposed are cell count >300, 81 -300, and <80 cells/mm 3 instead of <500, 201 -500, <200 cells/mm 3 by R. Kannangia et al (2008) [5]. Attili VS et al (2005) have proposed Categories of CD4 counts as >280, 120 -280 and < or =120 cells/mm 3 [8].…”

Section: <470e+01 C/mlmentioning

confidence: 99%

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Role of HIV-1 Viral Load in Initiating Antiretroviral Therapy

Ingole¹,

Kukreja²,

Mehta³

2011

WJA

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Purpose: For commencement of Antiretroviral Therapy (ART), CD4 count and/or WHO clinical staging is used as the guide in India. In western countries along with clinical and immunological criteria, HIV-1 viral load is also used to start the patient on treatment. The present study was conducted to determine the role of viral load in taking decision on ART commencement in HIV-1 infected treatment naïve individuals. Method: A cross sectional study was carried out at the Integrated Counseling and Testing Centre (ICTC) in the Department of Microbiology at a Tertiary care teaching hospital after Institutional Ethics Committee approval. After obtaining written informed consent, HIV-1 infected patients who were clinically asymptomatic, ART naïve, having CD4 count <250 cells/mm3 and age more than or equal to 15 yrs were enrolled in this study. Blood sample was collected and viral load was estimated by COBAS<sup>®</sup> TaqMan<sup>®</sup> HIV-1 Test. Result: During the study period of one year, 8966 HIV-1 infected patients were referred for CD4 count estimation. Of these 1624 patients had CD4 count <250 cells/mm3 and 405 patients were treatment naïve. Of these 96 (23.70%) patients were clinically asymptomatic and were enrolled. Of those enrolled, ten (10.41%) had viral load less than 5000 copies/ml. Conclusion: Decision to start patient on ART can be made judiciously when viral load is used along with CD4 count estimation

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Section: Discussionsupporting

confidence: 88%

Section: <470e+01 C/mlmentioning

confidence: 99%

Role of HIV-1 Viral Load in Initiating Antiretroviral Therapy

Ingole¹,

Kukreja²,

Mehta³

2011

WJA

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“…[6] Viral load estimation was done using Artus RealArt™ HIV-1 kits (Qiagen Hamburg Gmbh, Germany) using Rotor-Gene™ 3000. [7] The genotypic resistance assay was carried out by sequencing the Pr and RT genes. HIV-1 RNA was extracted from plasma using QIAamp ® viral RNA extraction kit (Qiagen GmbH, Hilden, Germany).…”

Section: Introductionmentioning

confidence: 99%

Drug Resistant Mutations Detected by Genotypic Drug Resistance Testing in Patients Failing Therapy in Clade C Hiv-1 Infected Individuals From India

Kandathil

Kannangai

Verghese

et al. 2009

Indian Journal of Medical Microbiology

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Purpose: There has been an increase in the number of individuals administered antiretroviral therapy (ART) in India but treatment outcome is hampered by increasing development of drug resistance. Previous reports from India have shown M184V as the commonest mutation in treated individuals. However, there is no evidence for any protease mutations in these reports. This study was done to observe the common/unique mutational patterns observed in reverse transcriptase (RT) and protease (Pr) genes of clade C HIV-1 strains from individuals showing treatment failure in India. Materials and Methods: The assay was done by sequencing the Pr and RT genes of the HIV-1 strains from 18 individuals failing ART. Analysis was carried out using Stanford HIV drug resistance database (SHDB). The sequences were also submitted to the calibrated population resistance tool of SHDB and Rega HIV-1 sub typing tool. Phylogenetic analysis and quality control were performed with Mega 4. Results: Among the 20 strains, 19 showed resistance to both nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), one strain to NNRTIs and five strains showed protease inhibitors (PI) resistance and 3-class resistance. The most common mutation conferring NRTI resistance was M184V (90%) while K103N (45%) was the most common mutation conferring NNRTI resistance. The M46I mutation was seen in 20% of the Pr sequences. Conclusion: Resistance testing to check the prevalence of drug resistance mutations that arise following failure of the first line regimen to establish guidelines for second line regimens in India is a must. Studies are needed to confirm if mutation patterns that arise among clade C following failure of ART are the same as for clade B strains.

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“…As HIV disease progresses, CD4 cell counts decline, typically by about 30-100 cells/μl per year (depending on viral load), leaving a person increasingly vulnerable to infections and cancers. People with CD4 cell counts above 500 cells/μl generally have relatively normal immune function and are at low risk for OIs3031.…”

Section: Cd4 and Cd8 Cell Testsmentioning

confidence: 99%

Current practices in laboratory monitoring of HIV infection

Vajpayee¹,

Mohan²

2011

Indian J Med Res

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After a diagnosis of HIV infection is made, the patient needs to be monitored using both clinical assessment and laboratory markers. HIV/AIDS monitoring is essential in guiding when to recommend initiation of therapy. Clinical monitoring will include staging of the HIV/AIDS disease using either the presence or absence of HIV-related signs and symptoms using the WHO staging system. Various laboratory methods can be used to monitor the disease progression and to guide whether the patient will need antiretroviral therapy or not. Laboratory monitoring for patients who are not on drugs is done to provide information about the stage of illness; to enable the clinician to make decisions on treatment and to give information on prognosis of the patient. Patients on drugs are monitored to assess their response to treatment with antiretroviral drugs and to detect any possible toxicity and improvement associated with the antiretroviral drugs.

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Evidence for lower CD4<sup><b>+</sup></b> T cell and higher viral load in asymptomatic HIV-1 infected individuals of India: Implications for therapy initiation

Cited by 12 publications

References 8 publications

Role of HIV-1 Viral Load in Initiating Antiretroviral Therapy

Role of HIV-1 Viral Load in Initiating Antiretroviral Therapy

Drug Resistant Mutations Detected by Genotypic Drug Resistance Testing in Patients Failing Therapy in Clade C Hiv-1 Infected Individuals From India

Current practices in laboratory monitoring of HIV infection

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