Clinical and immunological outcomes after initiation of second line anti-retroviral therapy in people living with HIV

Introduction: Resistance to first-line Antiretroviral Therapy (ART) has been a major concern in People Living with HIV (PLHIV), which necessitates a switch to second-line therapy. Data regarding the outcomes of second-line ART, especially in patients receiving Lopinavir/Ritonavir and Atazanavir/Ritonavir based therapy in a resource-limited setting like India is limited. Aim: To determine the clinical and immunological response to second-line ART as measured by change in mean body weight, change in WHO staging and change in CD4 cell count respectively. Materials and Methods: This facility based cross-sectional was done on PLHIV who were initiated on second-line ART following first-line therapy failure between January 2010 and March 2015. The patients were followed up for a minimum duration of one year after initiating on second-line therapy. The data was collected using a semi-structured proforma. Data regarding the CD4 cell count, body weight and WHO clinical staging at second-line ART initiation, at six months and one year after second-line ART was collected. Statistical analysis was done using ANOVA with Bonferroni test and proportions were compared using chi-square test. Results: A total of 110 patients who received second-line ART following first-line therapy failure were analysed. Majority 75 (68.2%) were males. The mean baseline body weight at the start of the second-line therapy was 50.65±7.9 kg which increased to 53.02±7.93 kg and 54.69±8.16 kg at 6 and 12 months of therapy respectively. The number of patients categorised as WHO Stage 3/Stage 4 reduced to 25 and 6 at the end of 6 and 12 months of therapy respectively. The mean baseline CD4 count at the start of the therapy was 210.95±104.53 cells/mm3 which increased to 352.15±149.78 cells/mm3 and 417.01±147.80 cells/mm3 at 6 and 12 months respectively. There were a total of nine deathsin present study. Conclusion: Second-line ART has a satisfactory outcome in terms of clinical and immunological improvement following first-line failure in PLHIV