To Evaluate the Outcome of Second Line Anti-Retroviral Therapy in HIV Positive Patients at Tertiary Care Centre
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Background: Roughly 4% of the 1.25 million patients on antiretroviral therapy (ART) in Asia are using second-line therapy. To maximize patient benefit and regional resources it is important to optimize the timing of second-line ART initiation and use the most effective compounds available. Methods: This prospective study was carried out at a tertiary care hospital among HIV-infected patients who was failed on first-line treatment and started on second-line HAART during October 2020 to September 2021 and formed the cases of the study and registered at ART centre, Ajmer. Ethical approval was obtained from the Institutional Ethics Committee of this institution. Result: In our study at baseline of 2nd line ART initiation mean CD4 cell count was 299.04 cells/ul ; at 6 months of 2nd line ART therapy mean CD4 cell count was 334.24 cells/ul and at 12 months mean CD4 cell count was 396.82 cells/ul. Change in CD 4 count from 6 months to baseline was 35.20 (P value 0.001) and change in CD 4 count from 12 months to baseline was 97.78(P value 0.001). The mean CD4 cell count is found to be increased from baseline to successive follow-ups. The increase in CD4 count is statistically significant (P value <0.05) at 6 and 12 months from baseline. Conclusion: Second line ART was found to achieve statistically significant (P value <0.05) clinical effectiveness (weight increase), virological effectiveness (viral load decrease), immunological effectiveness (CD4 count increase) at 6 and 12 months from baseline.
背景：亚洲地区接受抗逆转录病毒治疗（antiretroviral therapy, ART）的125万患者中，约4%正在使用二线治疗方案。为最大化患者获益并优化区域医疗资源配置，优化二线ART启动时机并选用现有最有效的复方制剂至关重要。 方法：本前瞻性研究于印度阿杰梅尔的三级医疗中心开展，研究对象为2020年10月至2021年9月期间一线治疗失败、启动二线高效抗逆转录病毒治疗（highly active antiretroviral therapy, HAART）的HIV感染者，所有受试者均在阿杰梅尔ART中心登记备案。本研究已获得本机构伦理委员会的伦理审查批准。 结果：本研究中，二线ART启动时的基线CD4细胞计数均值为299.04个/μL；二线ART治疗6个月时，CD4细胞计数均值为334.24个/μL；治疗12个月时，CD4细胞计数均值为396.82个/μL。相较于基线，治疗6个月时CD4计数变化量为35.20（P值=0.001），治疗12个月时变化量为97.78（P值=0.001）。从基线至后续各随访时间点，患者CD4细胞计数均值均呈上升趋势，且治疗6个月、12个月时的CD4计数升高均具有统计学意义（P值<0.05）。 结论：研究显示，二线ART在基线后6个月及12个月时，均可实现具有统计学意义（P值<0.05）的临床获益（体重增加）、病毒学获益（病毒载量降低）及免疫学获益（CD4计数升高）。
