Predictive markers of failure of first line anti retroviral treatment in HIV patients in India

Abstract

Background: In India where Anti-retroviral therapy (ART) is not guided by regular viral load assessment and genotyping resistance testing, there is need to find markers that can predict failure to ART. This study was done to find predictive markers of failure of first line ART in treatment-naive HIV patients in the National treatment programme running in India. Methods: A retrospective case control study was done at ART centre, Department of Medicine, S. S. Hospital, Banaras Hindu University, Varanasi and Uttar Pradesh. Cases were patients who failed first line ART and started on second line ART from December 2008 to January 2011.Patients well tolerating on first line ART since five years (2005) was taken as controls. Various factors were analysed in both groups and comparison was done to find their level of significance. Results: Seventy eight (78) patients who failed first line ART (cases) and 202 patients in control group were analysed. Mean Baseline CD4 count of cases (103.92 ± 87.27) were significantly lower than control group (206.93 ± 169.91) [p<0.0001]. Failure group had significantly higher mean age (38.10 ± 7.89 yrs) as compared to control (35.35 ± 7.58) [p<0.008]. Peak CD4 count in failure group [236.19 ± 165.88; median=197; IQR=159.8 (126.7.296.5)] was significantly lower than control group [676.70 ± 276.20; median =690.5; IQR=368(466,834)] {p<0.001}. The median time to reach peak CD4 count was significantly less in failure group [median=18 months; IQR=21(7.5, 28.5)] as compared to control group [median=58months; IQR=18(36, 54)] {p<0.001}. Patients who were in the failure group had a higher proportion of patients with a negative change in weight (73.1%) and higher number of patients with history of tuberculosis (59%). Conclusions: Monitoring of time to achieve peak CD4 count and level of peak CD4 count achieved were found to be the novel factors besides other inexpensive markers, which can predict the failure of first line ART. © 2013 Singh A, et al.