Seema Patrikar1, Subramanian Shankar2, Atul Kotwal3, D R Basannar4, Vijay Bhatti5, Rajesh Verma6, Sandip Mukherji7. 1. Lecturer in Statistics, Dept of Community Medicine, Armed Forces Medical College, Pune 411040, India. 2. Senior Advisor (Medicine & Clinical Immunology), Command Hospital (Air Force) Bengaluru, India. 3. Dy DGAFMS (Pension), O/o DGAFMS, Ministry of Defence, 'M' Block, New Delhi, India. 4. Scientist 'F', Dept of Community Medicine, Armed Forces Medical College, Pune 411040, India. 5. Director Medical Services (Health), O/o DGAFMS, Ministry of Defence, New Delhi, India. 6. Consultant (Dermatology), Base Hospital, Lucknow, UP, India. 7. Professor & Head, Dept of Community Medicine, Armed Forces Medical College, Pune 411040, India.
Abstract
BACKGROUND: As HIV steps into the third decade, there are more number of patients living on lifelong (antiretroviral therapy) ART and facing the threat of drug resistance with subsequent treatment failure. The aim of this study was to determine predictors of first-line ART failure with the objectives to estimate the burden of 2nd line ART. METHODS: A retrospective 5-year cohort of HIV patients who were initiated on first line ART in 2008-09 was studied. Patients were followed from the time of ART initiation. Kaplan-Meier methods and Cox proportional hazards regression models were used to estimate probabilities and predictors of first line ART failure. RESULTS: Of the total of 195 patients initiated on first line ART, 15 patients were switched to second line ART yielding 7.69% failure rate. During the 7178 person-years of follow-up, the incidence of first line ART failure was 2.09 per 1000 person-years. The Kaplan-Meier survival analysis gave a mean survival time of 55.6 months. BMI, CD4 count at ART initiation and presence of opportunistic infections were significant predictors of first line ART failure. The burden of second line ART patients by the end of 5 years of first line ART is expected to be 151 patients. CONCLUSION: Though the first line ART failure is quite low in this study, we still need to be vigilant for lower BMI, low baseline CD4 count and occurrence of opportunistic infections to efficiently manage failures on first line ART.
BACKGROUND: As HIV steps into the third decade, there are more number of patients living on lifelong (antiretroviral therapy) ART and facing the threat of drug resistance with subsequent treatment failure. The aim of this study was to determine predictors of first-line ART failure with the objectives to estimate the burden of 2nd line ART. METHODS: A retrospective 5-year cohort of HIVpatients who were initiated on first line ART in 2008-09 was studied. Patients were followed from the time of ART initiation. Kaplan-Meier methods and Cox proportional hazards regression models were used to estimate probabilities and predictors of first line ART failure. RESULTS: Of the total of 195 patients initiated on first line ART, 15 patients were switched to second line ART yielding 7.69% failure rate. During the 7178 person-years of follow-up, the incidence of first line ART failure was 2.09 per 1000 person-years. The Kaplan-Meier survival analysis gave a mean survival time of 55.6 months. BMI, CD4 count at ART initiation and presence of opportunistic infections were significant predictors of first line ART failure. The burden of second line ART patients by the end of 5 years of first line ART is expected to be 151 patients. CONCLUSION: Though the first line ART failure is quite low in this study, we still need to be vigilant for lower BMI, low baseline CD4 count and occurrence of opportunistic infections to efficiently manage failures on first line ART.
Entities:
Keywords:
Antiretroviral therapy; First line ART failure; Human immunodeficiency virus; Survival
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