Background: Antiretroviral therapy is one of the reasons for falling trend of HIV epidemic at present. The clinical efficacy, toxicity and reasons for failure of first line ART is understudied. This study aimed to determine the frequency rates and reasons for discontinuation of first line ART in a cohort of HIV positive adult patients.Methods: Cross sectional study was conducted on 11,968 patients of HIV registered at Victoria Hospital ART centre from 2011 to 2017. Using a structured proforma, relevant information was collected from patients taking first line ART. Descriptive statistics was used for analysing the results obtained.Results: Total 11,968 HIV patients were registered at ART centre during our study period of which only 4,008 patients were taking ART among them, 167 patients were referred for initiation of 2nd line ART. After evaluation 28 were continued on First line,1 opted out, 20 were transferred out,1 discontinued treatment, 17 died, 14 were lost to follow up, 5 were excluded from the study and only 81 patients were started on second line ART. Failure rate of first line ART in our study was 2.02%. Immunological failure followed by clinical failure were the most common reasons for changeover in this study. Tuberculosis was the most common comorbid disease in this study.Conclusions: First line ART is very effective and well tolerated and has a low failure rate. Low CD4 count, anaemia, raised ALP, low albumin were among the factors associated with treatment failure. WHO staging did not correlate with the treatment failure, recommended routine viral load monitoring for assessing treatment failure.
Background: Highly active anti-retroviral therapy (HAART) increases the longevity of the patients infected with Human immunodeficiency virus (HIV) so mortality due to opportunistic infections is reducing and late complications like cardiovascular manifestations are on its rise. Cardiac involvement can be over-looked in HIV positive patients because symptoms of breathlessness, fatigue and poor exercise tolerance are ascribed to other conditions associated with HIV patients. Objective: Primary objective was to evaluate cardiac manifestations and determine type of cardiac involvement in both HAART naïve patients and patients on HAART and correlate with CD4+ counts. Methods: 200 HIV infected patients presenting in outpatient department (OPD) and inpatients are included. Information is collected and detailed history is taken using pre-formed proforma. At the time of admission or follow up, steps are taken to send for all the investigations and detailed clinical examination of the patient done, focusing more on cardiovascular system. Results: 41% of the patients with normal cardiac function were not on HAART and 62.7% of the patients with cardiac dysfunction were HIV naïve and it was found to be statistically significant (p value 0.003). Tricuspid regurgitation (42.1% verus 57.9%, p value 0.035) and Ischemic heart disease (IHD) (0% versus 100% p value 0.049) found to have significant association in patients who were on HAART. Systolic dysfunction (p value 0.048) and IHD (p value 0.019) were both significantly associated with the low CD4+ counts in patients not on HAART. Conclusion: There was significant association of HAART on the occurrence of cardiac dysfunction. Cardiac dysfunction is noted with low CD4+ counts, it is therefore important to undergo 2-dimensional echocardiography (2-D Echo) at diagnosis and at regular intervals in all HIV infected patients and to initiate early treatment for the same.the rural population.
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