Virological failure among people living with HIV receiving second-line antiretroviral therapy in Pune, India

BMC Infectious Diseases

Research

Smita Nimkar¹  Amol Chavan¹  Neetal Nevrekar¹  Sandesh Patil¹  Priyanka Raichur¹  Ivan Marbaniang²  Vidya Mave³  Nikhil Gupte³  Sonali Salvi⁴  Shashikala Sangle⁴  Dileep Kadam⁴ 

[1] Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, 411001, Pune, Maharashtra, India;Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, 411001, Pune, Maharashtra, India;Department of Epidemiology, McGill University, Montreal, QC, Canada;Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, 411001, Pune, Maharashtra, India;Johns Hopkins University School of Medicine, Baltimore, MD, USA;Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India;

关键词: HIV/AIDS;    Second-line antiretroviral;    Virological failure;    Adherence;    Protease inhibitors;   

DOI  :  10.1186/s12879-022-07894-2

 received in 2021-11-18, accepted in 2022-11-24,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe number of people receiving second-line antiretroviral therapy (ART) has increased as global access to ART has expanded. Data on the burden and factors associated with second-line ART virologic failure (VF) from India remain limited.MethodsWe conducted cross-sectional viral load (VL) testing among adults (≥ 18 years) who were registered at a publicly funded ART center in western India between 2014 and 2015 and had received second-line ART for at least 6 months. Sociodemographic and clinical characteristics were abstracted from routinely collected programmatic data. Logistic regression evaluated factors associated with VF (defined as VL > 1000 copies/mL).ResultsAmong 400 participants, median age was 40 years (IQR 34–44), 71% (285/400) were male, and 15% (59/400) had VF. Relative to participants without VF, those with VF had lower median CD4 counts (230 vs 406 cells/mm3, p < 0.0001), lower weight at first-line failure (49 vs 52 kg, p = 0.003), were more likely to have an opportunistic infection (17% vs 3%, p < 0.0001) and less likely to have optimal ART adherence (71% vs 87%, p = 0.005). In multivariable analysis, VF was associated with opportunistic infection (aOR, 4.84; 95% CI, 1.77–13.24), lower CD4 count (aOR 4.15; 95% CI, 1.98–8.71) and lower weight at first-line failure (aOR, 2.67; 95% CI, 1.33–5.34).ConclusionsWe found second-line VF in about a sixth of participants in our setting, which was associated with nearly fivefold increased odds in the context of opportunistic infection. Weight could be a useful clinical indicator for second-line VF.

【 授权许可】

CC BY   
© The Author(s) 2022

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