Aim of study: To evaluate clinical and immunological response after starting antiretroviral therapy (ART) in HIV positive patients without initial active opportunistic infections and to look for unmasking type of IRIS cases.
Study design: continuous, longitudinal, prospective cohort, comparative study.
Place of study: ART centre, New Civil Hospital, Surat.
Methodology: Each patient was observed for 6 months from January 2009 to July 2010. The patients who are more than 15 year of age, ART Naïve, who were eligible according to NACO guidelines (2008)1 to ART were included in the study. Patients who lost follow up; stopped treatment during study and who had active opportunistic infections at start of ART were excluded. Each patient is followed up for 6 month duration. Patients were regularly followed up as on given date& time, for total 5 visits. CD4 count is repeated after six months except for suspected cases of IRIS.
Results: The mean age of study population was 36.37 yrs & male to female ratio was 64:36 and 81% were married, 13% widowed, 70% were from Surat district . Mode of transmission was heterosexual in all patients. ZLN- Zidovudine (ZDV) + lamivudine (LMV) + nevirapine (NVP) , was started in 90 patients initially and SLN- Stavudine(STV) + lamivudine (LMV) + nevirapine(NVP), in 10 patients, 19 Patients out of 90 of ZLN develop anaemia during follow up (21.1%). ART therapy was effective for WHO stage I, II &III, functional status W (working) & A (ambulatory). Least effective in WHO stage IV and functional status B (bedridden). Weight gain was observed in 80.2 % of patients .Candidiasis was most common opportunistic infection observed.CD4 count increased in 94.6% of cases. Unmasking form of IRIS was observed in total 4 patients, 3 died (2 have Tuberculosis and 1 had Toxoplasmosis), and 1patient with tuberculosis survives. Mortality was 6.2% cases. Total 6 patients expired, 3 lost to follow up, 3 patients had their CD4 count decreased and 2 had no change, in rest of patients CD4 count increased. A good level of adherence was seen, only 3% cases lost to follow up.
Conclusion: Significant improvement observed which is correlating with other studies nationally and internationally.
