Clinical and Immunological Profile of Patients on Antiretroviral Therapy (original) (raw)
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Prevalence of Opportunistic infections in HIV patients on ART.
IOSR Journals , 2019
Results: Majority of the patients around 60 % were in the age group from 40 to 60 years of age, followed by 32 % from age group 20 to 40 years. Male patient constitute 73 % and 27 % were female. Of the total 92 patients 47, which is 51.1 %, had either single or multiple OIs. Out of these 47 patients with OIs, 30 had CD4 count below 200 cells / cu. mm, comprising 64 % and 17 patients had CD4 count above 200 cells / cu. mm, constituting 36 % of the total patients having OIs. Discussion: This study observed that about 51.1 % of HIV patients on ART had one or more OIs. Tuberculosis and CMV were found to be the most common OIs. 47 patients were found to have OIs, of which 64 % patient had CD4 count ˂ 200 cells / cu. mm and 36 % had CD4 count above 200 cells / cu. mm, clearly showing higher risk of OIs in low CD4 count patients. Conclusion : This study showed the prevalence of OIs among HIV patients on ART is still high, which requires timely diagnosis and treatment for the better management of the patients with HIV on ART.
There are conflicting data regarding incidence of Opportunistic Infections in newly diagnosed HIV positive patients on ART. In this article, we studied incidence of Opportunistic Infections in newly diagnosed HIV positive in a tertiary care centre in North Bengal after one year of ART. One hundred and twenty patients were followed for one year after initiating ART. The most common opportunistic infections were Tuberculosis, Candidial infection, skin infections and diarrhea. At the baseline, 32 cases were present with tuberculosis (Pulmonary: 10, 6 sputum-ve and 4 sputum +ve, extrapulmonary: 22). Total patients with candidial infections were 15 (Oral: 12, Oesophageal: 3). After the 6 months of followup 13 patients presented with diarrhoea, 8 cases presented with oral candidiasis, 6 cases presented with tuberculosis. At 12 months of followup, 6 patients presented with tuberculosis, 4 cases with oral candidiasis and 3 cases with diarrhoea. Opportunistic infections at baseline were 60.4% among the study population, while after 6 and 12 months of ART it decreased to 33.7% and 16.8% respectively.
BMC Infectious Diseases, 2018
Background: The need to study the outcome of Antiretroviral Therapy (ART) among Human Immunodeficiency Virus (HIV) infected individuals in Ghana, a sub-Saharan African country crucial in the era of the "Treat All" policy. The aim of this study was to analyze selected determinants of immunological and virological response to ART among HIV infected individuals in a tertiary facility in Cape Coast, Ghana. Methods: An analytical cross sectional study with a retrospective component was conducted in the Cape Coast Teaching Hospital (CCTH), Central Region. Clients aged 18 years and above attending the HIV Clinics for ART and who were on ART for 6 months or more were recruited. The viral loads, CD4 count and other socio-demographic data were analyzed using STATA version 13 (STATA Corp, Texas USA). Descriptive analysis was done and presented with appropriate measures of central tendencies. In addition, bivariate and multivariate analysis was carried out with p value of 0.05 interpreted as evidence of association between variables. Results: A total of 440 participants were included in this study with a mean age of 45.5 (±11.6) years. The mean CD4 count at baseline, 6 months on ART and currently at study recruitment were 215.1 cells/mm 3 (±152.6), 386.6 cells/mm 3 (±178.5), and 579.6 cells/mm 3 (±203.0) respectively. After 6 months and 12 months on ART, the number who had achieved viral copies < 1000/ml were 149 (47.0%) and 368 (89.6%) respectively. There was strong evidence of an association between having CD4 count < 350 cells/mm 3 after 6 months on ART and having a diagnosis of tuberculosis since HIV diagnosis (aOR 8.5, 95% CI 1.1-73.0, p = 0.05) and clients having plasma viral load > 1000 copies/ml after 6 months on ART (aOR 2.0, 95% CI 1.2-3.2, p = 0.01). Conclusion: There was good response to ART among clients, high virological suppression and immunological recovery hence low rates of change to second line ART regimen in this cohort studied. With strict adherence to the national policy on HIV testing, management of positive clients and full implementation of the "Treat All" policy, Ghana could achieve, if nothing at all, the third "90, 90, 90" target by 2020.
International Journal of Basic and Clinical Pharmacology, 2016
Background: Human immunodeficiency virus (HIV) presently accounts for the highest number of deaths due to any infective agent in the world. The present study assessed the one year treatment outcome following antiretroviral therapy in HIV positive, treatment naïve patients in a tertiary care hospital. Methods: Adult HIV positive, antiretroviral treatment naive patients who were started on antiretroviral therapy (ART) between 1 st January 2011 and 31 st May 2013 were included in the study. Data was collected from their case records. CD4+cell count, haemoglobin level, weight, occurrence of opportunistic infections (OIs) and adverse drug reactions (ADRs) were analysed at baseline, 6 and 12 months following start of antiretroviral therapy. Data was analysed using parametric and nonparametric tests. Results: Data of 325 patients was analysed. Overall, the median increase in CD 4 + count at 1 year after initiation of treatment was observed to be clinically significant. Patients on tenofovir based regimen showed a significantly greater increase in the median CD 4 + count (P = 1.12×10-05) and haemoglobin (P = 0.002) as compared to those on non-tenofovir based regimen. A total of 151 ADRs were recorded in the study, of which the most common were skin rash 24%, anaemia and gastrointestinal side effects 17% each. Frequency of opportunistic infections gradually declined after ART. At the end of 1 year of treatment, the cumulative loss to follow up was 7.4%. Conclusions: By following the current national guidelines, the desired immunological and clinical response following initiation of ART can be achieved while minimizing drug toxicity.
International Journal of Community Medicine and Public Health, 2016
Human immunodeficiency virus infection (HIV) remains a worldwide health crisis. Nearly 40 million people infected, 95% of them lives in developing countries like India , Africa etc. 1 With a widespread use of antiretroviral (ARV) drugs, the once fatal disease is now a manageable chronic illness. 2 The drugs improve immune status, reduce viral load, and incidence of hospitalization and mortality. 3,4 Many people do not experience symptoms when first infected with HIV; however some have a flu-like illness within a month or two after exposure to the virus. Even during the asymptomatic period, the virus is actively multiplying, infecting and killing cells of the immune system. The virus can also hide within infected cells and ABSTRACT Background: To assess the immunological and clinical progress of human immunodeficiency virus/acquired immune deficiency syndrome patients on antiretroviral therapy at antiretroviral therapy (ART) center Bhopal, Madhya Pradesh, India. Methods: Retrospective medical records review was conducted to determine the immunological and clinical progress of HIV/AIDS patients. The records of patients on their clinical stage, cluster of differentiation 4 (CD4) Count, and working status were reviewed. Results: A total number of 5295 patients were included in the study. The mean age was 33.39 Years and standard deviation 11.84 years; it ranged from 0.5 to 82years. Number of males was 3441 (64.98%), females formed 1829 (34.54%), while transgender 25 (0.47%). Out of 5295 patients 3314 (%) are eligible and initiated ART. And out of 3314 patients, 1903 patients continue to be present at their follow up visit for regular clinical and pathological checkup. The mean weight of the patients increased from 49.59kg to 52.41 after 12 months of therapy. Mean CD4 cell counts as 231cells/mm 3 during the first follow up increase to 443 cells/mm 3 at 2 nd visit. Before ART 674 Patients were working and 373 were bedridden and after 1 year of ART 1028 were became belongs to working group and only 197 were remains bedridden. Percentage of patients in stage III became 38.94% (from 48.84%) followed by Stage II 38.36% (from 23.08%). Conclusions: Study concluded that the patients taken ART were shown to experience improved health status in general.
Background: Opportunistic infections (OI) are the major cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals. The pattern of OIs differs widely, hence it is necessary to correlate spectrum of OIs and CD4 counts among HIV infected individuals in specific localities. Materials and Methods: The present study describes the clinical and laboratory profiles of different OIs among 55 HIV seropositive patients. CD4 count was estimated and antiretroviral therapy (ART) was started in 27 patients as per National Acquired Immunodeficiency Syndrome Control Organization guidelines. These 27 patients were classified into stage 1, stage 2 and stage 3 based on CD4 counts of >500 cells/µl, 200-499 cells/µl and <200 cells/µl respectively. The OIs presented by respective groups were documented. Results: Pulmonary tuberculosis was found to be the most common OI constituting 43.6% of all cases followed by candidiasis (30.9%), cryptosporidial diarrhea (21.8%), herpes zoster (16.3%), cryptococcal meningitis (3.63%), Pneumocystis jirovecii pneumonia (1.81%), and other miscellaneous infections (23.6%). Only 1 patient was found in stage I while 13 patients each were grouped in stage II or stage III. The mean CD4 count in our study population who were on ART was 230 ± 150 cells/μl. Conclusion: The pattern of OIs among our study group did not differ significantly from patients not receiving ART. The effect of ART on CD4 count differs from patient to patient based on the degree of depletion of CD4 count before the initiation of ART, drug adherence, concomitant OIs and their treatment.
https://www.ijrrjournal.com/IJRR\_Vol.6\_Issue.5\_May2019/Abstract\_IJRR0010.html, 2019
Introduction: The treatment outcomes under national antiretroviral therapy (ART) programme are being evaluated in ART centers in the country. We carried out this study to analyze the impact of first line antiretroviral therapy in HIV infected patients attending free ART. The main objective of this work is to determine the clinical and immunological failure rate at first-line treatment. Methods: We have conducted a prospective, observational cohort study of patients living with HIV who had suspected failure of first line ART using data collected under programmatic condition. Four hundred and three patients from ART center King, 403 patients were registered in the ART clinic. Of these, 318 (52.6%) were on ART. Females accounted for 48% and males constitute 51%. Patients had a mean age of 37 ± 12 yr, Median CD4 count was 560 cells/μl (IQR: 289-734). 13 patients (4.2%) were in clinical stage 3 and 10 (8.24%) in clinical stage 4 for HIV infection according to the WHO classification. CD4 T-cells counts were between 4 and 1591 cells/mm3 with 174 patients (56%) with CD4 count below 500 cells/mm3. Conclusion: The rate of immunological failure rate of first-line antiretroviral treatment of patients under treatment in King Koti, Hyderabad is 7.5% for the year 2017and 18.
National Journal of Medical Research, 2014
Background: Acquired immunodeficiency syndrome (AIDS) is a disease caused by the retrovirus human immunodeficiency virus (HIV) and characterised by profound immuno-suppression that leads to opportunistic infections. The present study was conducted with an objective to study demographic and clinical profile of PLWHA attending ART Centre SVBP Hospital Meerut. Methodology: This cross sectional study was conducted on HIV positive cases registered in ART Centre or admitted in the medicine department of LLRM Medical College, Meerut. A pre-tested semi-structured questionnaire was prepared and information regarding demographic and clinical profile of the cases was collected. Results: Out of 800 cases, 534 cases (66.75%) were male and 266 cases (33.25%) were female. Mean age of male was 34.62±10.2 years and 32.12 ± 9.62 for female. As many as 54 (6.99%) patients were sputum positive for AFB, 492 (61.48%) patients were anaemic, 276 (34.53%) patients had macrocytic, 182 (22.75%) had microcytic anemia. Physical examination showed 426 (53.29%) febrile, 443 (55.37%) prostration, oral ulcers 81 (10.17%), pigmentation 268 (33.53%), 295 (36.92%) pallor, jaundice was present in 33 (4.19%), Lymphadenopathy 138 (17.36%), genital and skin involvement was 19(2.39%) and 27 (3.39%) respectively. Conclusion: The present study suggests that HIV/AIDS have highest prevalence in sexually active and economically productive age group, person with low socio-economic status and rural area, more in illiterate and person having lack of knowledge for HIV/AIDS. Fever and prostration was predominant clinical features on presentation.
Original article , 2021
Background: Although HAART has successfully controlled the progression of HIV and helped to prevent the disease significantly, new challenges are heading up and ART failure despite of good adherence is becoming a major hurdle in the way of HIV control. Considering these facts present study was planned with an objective to study clinical and immunological profile of antiretroviral therapy failure HIV patients. Methods: This observational study was conducted at ART plus centre of one of the tertiary health care centre of India from February 2018 to September 2019. Patients satisfying inclusion and exclusion criteria were interviewed by using semi-structured questionnaire and were examined and investigated for any opportunistic infections and their CD4 counts were studied. Results: Among total 4098 patients alive on ART at present study centre 90.6% were responding well to the 1st line of ART, while 8.7% had failed to 1st line of ART but responding well to the 2nd line whereas 0.7% had failed to 2nd line and were initiated on 3rd line of ART. Failure of ART was the cause for change in regimen among 84.9% of patients. Median of rise in CD4 count at 6 months from switch to 2nd line was 137 cells/mm3. Conclusions: Antiretroviral therapy has significantly improved outcome of the disease. Failure of ART is the major cause for change in ART regimen. Majority of patients in failure had WHO clinical stage 1 and 2.