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BMC Infectious Diseases

Open Access

Effectiveness of targeted viral load strategy in a public health HIV/AIDS programme

  • Rajyasree De1,
  • Nivedita Dutta1,
  • Dolanchampa Modak1,
  • Shantasil Pain2,
  • Sripati Dasmohapatra3,
  • Sukamal Bisoi4 and
  • Subhasish Kamal Guha1Email author
BMC Infectious Diseases201414(Suppl 3):O22

https://doi.org/10.1186/1471-2334-14-S3-O22

Published: 27 May 2014

Background

Targeted viral load (VL) strategy is followed in the ART programme of India. Patients failing antiretroviral therapy, undergo VL testing and switched to 2ndline ART if VL is >5000 copies/ml.

Methods

Data of patients referred to School of Tropical Medicine, Kolkata for suspected treatment failure (TF) was analyzed for the period of December2008 to November2013 to ascertain the positive predictive value (PPV) of immunologic and/or clinical parameter for confirming virologic failure (VF) and to observe the short term outcome of secondline treatment. Paired t- test was used for data analysis.

Results

VF was noted in 287(51.3%) of 560 patients (median age 37 years; male–436(77.85%); median CD4 109 cells/mm3 at suspected TF. Number of patients failing by immunologic, clinical and clinicoimmunologic criteria was 414(74%), 11(2%) & 135(24%) respectively with corresponding PPV of 48%, 46% & 63% respectively. PPV of CD4 falling below baseline, >50% drop from on-treatment peak value and failure to reach 100 cells/mm3 after 12 months of ART was 37%, 55% and 25% respectively. Among 216 patients with minimum 6 months follow-up, the median CD4 & VL changed significantly following 6 months of secondline ART (103.5 to 232 cells/mm3; p<0.0001 and 4.04 to 2.6 log10 copies; p<0.0001 respectively). Undetectable VL was achieved in 164(76%). Out of 284 patients starting secondline ART, 25 (8.8%) died within 6 months.

Conclusion

Immunoclinical criteria have low PPV in diagnosing VF. Despite late switch, majority (76%) could achieve undetectable VL at 6 months but the high early mortality (8.8%) is a concern.

Authors’ Affiliations

(1)
Centre of Excellence in HIV Care, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
(2)
Department of Medicine, North Bengal Medical College, Darjeeling, West Bengal, India
(3)
Care, Support & Treatment Division, West Bengal State AIDS Prevention & Control Society, Kolkata, West Bengal, India
(4)
Department of Community Medicine, RG Kar Medical College, Kolkata, West Bengal, India

Copyright

© De et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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