Outcome of patients on second line antiretroviral therapy under programmatic condition in India

Chakravarty, Jaya; Sundar, Shyam; Chourasia, Ankita; Singh, Pallav Narayan; Kurle, Swarali; Tripathy, Srikanth; Chaturbhuj, Devidas N.; Rai, Madhukar; Agarwal, Amit Kumar; Mishra, Rahul; Paranjape, Ramesh

doi:10.1186/s12879-015-1270-8

Cited by 43 publications

(48 citation statements)

References 26 publications

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“…The failure rate and overall outcomes of this patient cohort are better than in other studies from similar resource-limited settings [2,5,7,8,13]. A multi-centric study with follow-up duration of three years showed that the probability of survival at one year was 0.86 and at two years it was 0.77 [8].…”

Section: Discussionmentioning

confidence: 76%

“…Risk factors for unfavorable outcomes in our own study and in other studies have consistently included high viral load and low CD4 counts at baseline, having a history of being lost to follow-up and experiencing delayed switching to second-line ART after first-line failure [2,7,8,13,25]. Although there were small numbers of patients who were injection drug users in our study, they have a higher risk of developing unfavorable outcomes similar to what has been shown elsewhere [21].…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcomes of second-line antiretroviral treatment in an adult and adolescent cohort in Myanmar

Kyaw¹,

Kumar

Oo³

et al. 2017

Global Health Action

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Background: Myanmar has a high burden of Human Immunodeficiency Virus (HIV) and second-line antiretroviral treatment (ART) has been available since 2008 in the public health sector. However, there have been no published data about the outcomes of such patients until now.Objective: To assess the treatment and programmatic outcomes and factors associated with unfavorable outcomes (treatment failure, death and loss to follow-up from care) among people living with HIV (aged ≥ 10 years) receiving protease inhibitor-based second-line ART under the Integrated HIV Care Program in Myanmar between October 2008 and June 2015.Design: Retrospective cohort study using routinely collected program data.Results: Of 824 adults and adolescents on second-line ART, 52 patients received viral load testing and 19 patients were diagnosed with virological failure. However, their treatment was not modified. At the end of a total follow-up duration of 7 years, 88 (11%) patients died, 35 (4%) were lost to follow-up, 21 (2%) were transferred out to other health facilities and 680 (83%) were still under care. The incidence rate of unfavorable outcomes was 7.9 patients per 100 person years follow-up. Patients with a history of injecting drug use, with a history of lost to follow-up, with a higher baseline viral load and who had received didanosine and abacavir had a higher risk of unfavorable outcomes. Patients with higher baseline C4 counts, those having taken first-line ART at a private clinic, receiving ART at decentralized sites and taking zidovudine and lamivudine had a lower risk of unfavorable outcomes.Conclusions: Long-term outcomes of patients on second-line ART were relatively good in this cohort. Virological failure was relatively low, possibly because of lack of viral load testing. No patient who failed on second-line ART was switched to third-line treatment. The National HIV/AIDS Program should consider making routine viral load monitoring and third-line ART drugs available after a careful cost–benefit analysis.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of second-line antiretroviral treatment in an adult and adolescent cohort in Myanmar

Kyaw¹,

Kumar

Oo³

et al. 2017

Global Health Action

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“…However, we used this failure rate to maintain a conservative modelling approach. Patients confirmed to have virologically failed first‐line therapy and have had a one‐time opportunity for re‐suppression were then switched to a subsequent and last PI‐based ART regimen of atazanavir (ATV)/ritonavir/TDF/3TC .…”

Section: Methodsmentioning

confidence: 99%

The cost‐effectiveness and budgetary impact of a dolutegravir‐based regimen as first‐line treatment of HIV infection in India

et al. 2018

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IntroductionDolutegravir (DTG)‐based antiretroviral therapy (ART) is recommended for first‐line HIV treatment in the US and Europe. Efavirenz (EFV)‐based regimens remain the standard of care (SOC) in India. We examined the clinical and economic impact of DTG‐based first‐line ART in the setting of India's recent guidelines change to treating all patients with HIV infection regardless of CD4 count.MethodsWe used a microsimulation of HIV disease, the Cost‐Effectiveness of Preventing AIDS Complications (CEPAC)‐International model, to project outcomes in ART‐naive patients under two strategies: (1) SOC: EFV/tenofovir disoproxil fumarate (TDF)/lamivudine (3TC); and (2) DTG: DTG + TDF/3TC. Regimen‐specific inputs, including virologic suppression at 48 weeks (SOC: 82% vs. DTG: 90%) and annual costs ($98 vs. $102), were informed by clinical trial data and other sources and varied widely in sensitivity analysis. We compared incremental cost‐effectiveness ratios (ICERs), measured in $/year of life saved (YLS), to India's per capita gross domestic product ($1600 in 2015). We compared the budget impact and HIV transmission effects of the two strategies for the estimated 444,000 and 916,000 patients likely to initiate ART in India over the next 2 and 5 years.ResultsCompared to SOC,DTG improved 5‐year survival from 76.7% to 83.0%, increased life expectancy from 22.0 to 24.8 years (14.0 to 15.5 years, discounted), averted 13,000 transmitted HIV infections over 5 years, increased discounted lifetime care costs from $3040 to $3240, and resulted in a lifetime ICER of $130/YLS, less than 10% of India's per capita GDP in 2015. DTG maintained an ICER below 50% of India's per capita GDP as long as the annual three‐drug regimen cost was ≤$180/year. Over a 2‐ or 5‐year horizon, total undiscounted outlays for HIV‐related care were virtually the same for both strategies.ConclusionsA generic DTG‐based regimen is likely to be cost‐effective and should be recommended for initial therapy of HIV infection in India.

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“…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. In another study [7]interestingly, 17/50 (34.0 %) of patients who had ongoing viremia or virological failure at 6 months adequately suppressed their viral load at 12 months. Another Similar findings were observed in a study where 62 % patients suspected of second-line ART failure, responded to enhanced adherence support and had a two-log decrease in their level of HIV on subsequent VL testing [8].…”

Section: Discussionmentioning

confidence: 93%

Virological outcomes of second-line antiretroviral therapy for HIV-1 patients in center of excellence, Gandhi Hospital, Secundrabad, Telangana

et al. 2019

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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.

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Outcome of patients on second line antiretroviral therapy under programmatic condition in India

Cited by 43 publications

References 26 publications

Long-term outcomes of second-line antiretroviral treatment in an adult and adolescent cohort in Myanmar

Long-term outcomes of second-line antiretroviral treatment in an adult and adolescent cohort in Myanmar

The cost‐effectiveness and budgetary impact of a dolutegravir‐based regimen as first‐line treatment of HIV infection in India

Virological outcomes of second-line antiretroviral therapy for HIV-1 patients in center of excellence, Gandhi Hospital, Secundrabad, Telangana

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