Virological failure among people living with HIV receiving second-line antiretroviral therapy in Pune, India

Abstract

Background The number of people receiving second-line antiretroviral therapy (ART) has increased as global access to ART has expanded. Data on the burden and factors associated with second-line ART virologic failure (VF) from India remain limited. Methods We conducted cross-sectional viral load (VL) testing among adults (≥ 18 years) who were registered at a publicly funded ART center in western India between 2014 and 2015 and had received second-line ART for at least 6 months. Sociodemographic and clinical characteristics were abstracted from routinely collected programmatic data. Logistic regression evaluated factors associated with VF (defined as VL > 1000 copies/mL). Results Among 400 participants, median age was 40 years (IQR 34–44), 71% (285/400) were male, and 15% (59/400) had VF. Relative to participants without VF, those with VF had lower median CD4 counts (230 vs 406 cells/mm3, p < 0.0001), lower weight at first-line failure (49 vs 52 kg, p = 0.003), were more likely to have an opportunistic infection (17% vs 3%, p < 0.0001) and less likely to have optimal ART adherence (71% vs 87%, p = 0.005). In multivariable analysis, VF was associated with opportunistic infection (aOR, 4.84; 95% CI, 1.77–13.24), lower CD4 count (aOR 4.15; 95% CI, 1.98–8.71) and lower weight at first-line failure (aOR, 2.67; 95% CI, 1.33–5.34). Conclusions We found second-line VF in about a sixth of participants in our setting, which was associated with nearly fivefold increased odds in the context of opportunistic infection. Weight could be a useful clinical indicator for second-line VF.

Active tuberculosis incidence among treatment failure experienced patients in North Wollow Zone: A multicenter historical cohort

“…Patients in this category had a 13.2 times higher risk of developing TB compared to the reference group (AHR = 13.2, 95% CI: 2.894–60.34, p = 0.001). This finding is consistent with previous reports in Mekele 32 and India 33 . Patients in advanced disease stages (III and IV) may experience weakened immunity, leading to accelerated endogenous reactivation and an increased risk of latent bacilli becoming active TB in the lungs.…”

“…This can be attributed to factors such as insufficient follow‐up time, censoring, low event rate, and limitations in sample size. These challenges make it difficult to accurately estimate the median or half‐life time from the survival curve, often necessitating alternative methods or additional data for more precise estimation 32 and India 33 . The difference in outcomes for patients on the second‐line regimen may be due to factors such as CD4 count progression, lack of nutritional support, and treatment adherence issues leading to viral resistance and increased susceptibility to opportunistic infections.…”

“…These challenges make it difficult to accurately estimate the median or half‐life time from the survival curve, often necessitating alternative methods or additional data for more precise estimation 32 and India. 33 The difference in outcomes for patients on the second‐line regimen may be due to factors such as CD4 count progression, lack of nutritional support, and treatment adherence issues leading to viral resistance and increased susceptibility to opportunistic infections. Variations in follow‐up periods and sample size may also contribute to the observed differences.…”

“…This finding is consistent with previous reports in Mekele 32 and India. 33 Patients in advanced disease stages (III and IV) may experience weakened immunity, leading to accelerated endogenous reactivation and an increased risk of latent bacilli becoming active TB in the lungs. The compromised immune response associated with advanced disease stages contributes to the development of active TB.…”

Development and emerging trends of drug resistance mutations in HIV: a bibliometric analysis based on CiteSpace

“…The index of first-line therapy adherence serves as a predictor of second-line therapy adherence ( Ramadhani et al, 2014 ). Furthermore, it is thought that a patient’s weight may be associated with virologic failure ( Salvi et al, 2022 ). If second-line therapy fails, third-line therapy needs to be attempted.…”