Factors leading to failure of firstlineanti retroviral therapy (ART); a retrospective study in indianteritiary care government settings

Abstract

Background

HIV is a lenti virus that causes HIV infection in humans in which progressive failure of immune system allows life threatening opportunistic infections and cancers to thrive. So it is important to study the factors that lead to failure of first line ART.

Aims and Objectives

To find out the factors leading to failure of first line ART like socio-demographic factors, clinical factors, immunological factors, virological factors etc.To assess the CD4 count in subjects using first line and second line ART. To assess the viral load in subjects who failed first line ART.

Methodology

Retrospective cohort observational study was conducted to assess the factors leading to the failure of first line ART.  HIV patients who met inclusion criteria were informed consented and included in the study and relevant data was collected in a prior designed data collection form.

Results

 In our study we found that controls were more among 30-40 yrs age. Males and females were equally distributed in cases and controls. Widowed females were found more among cases. Illiterates were found more among cases than controls. Cases children were more HIV seropositives than controls. Cases were more in WHO stage-4 clinical staging than controls. Cases had more number of drug substitutions, drug related adverse effects, low medication adherence, more number of LFUS and hospitalisations than controls. Cases were more in number who travels more than 60 minutes and more time gap between diagnosis and time of ART initiation and cases had raised RFTS, LFTS, and lipid profile at time of treatment failure. Cases had more serious opportunistic infections than controls.

Conclusion

From our study we found that marital status, illiteracy, labour work, low income status, loss of follow up’s, wrong diagnosis of type of HIV virus initially that lead to the wrong treatment, positive family history of HIV,

recurrent stage 3, 4 infections, more no. of drug substitutions, zidovudine, stavudine based regimens, long time gap between diagnosis and ART initiation, long travel time to ART centre, more no. of drug related problems, more no. of recurrent opportunistic infections, more no. of hospitalisations, raised RFT’s, LFT’s, Lipid profile, lower adherence levels, low CD4 counts on long term use of ART were considered as factors that lead to first line ART failure.