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Dr. Sanveet Kumar Sheoran
Dr. Thingbaijam Shanti Devi
Dr. Ningthoukhongjam Reema
Dr Kshetrimayum Birendra Singh
Dr. Shehanaz N
Dr. Asfaq Ali
Dr Bidyapati Narengbam
Dr. Karthik YR


HIV/AIDS, HAART, second line ART, CD4 count, viral load


Introduction: HIV/AIDS progressively weakens immune system and make it susceptible to life threatening opportunistic infections, neurological disorders or certain unusual malignancies. Second-line ART is the next regimen used in sequence immediately after first-line therapy has failed. Hence, the criteria to switch to second line ART includes immunological and/or virological and/or clinical failure. Manipur is one of the high prevalence states for HIV infection in India. There is so far very little study and data regarding patients in the early phase of second line ART from this part of the country. The present study describes the clinical and immunological outcomes of PLHIV on PI-based second-line ART regimens in north-eastern India thereby identifying the need of change to third line ART, at an early stage. In addition, it determined the WHO clinical staging, CD4 counts and plasma viral load of patients on second line ART at 0 and 6 months and to assess the adherence of patients on second line ART.

Methods: This hospital based longitudinal study enrolled 73 HIV positive patients on second line ART, admitted in Medicine ward, attending Medicine OPD, Center of Excellence (Coe)ART Centre, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur (RIMS) from January 2021 to October 2022. Blood samples were sent for CD4 count, and plasma viral load at baseline and after 6 months on second line ART.

Results: The mean age group was 38.37±9.93 years, majority were males (n=56, 76%), the most common complaints were fever (27.40%), diarrhoea (20.55%) and the common source of infection was heterosexual and IVDU 38% and 32% respectively. The most common regime used was TDF+3TC+DTG (52%, 38). There was improvement in mean BMI {from 21.20(+1.69) to 22.3±1.58 kg/m2}, mean CD4 cell count (from 266 cells/mm3 to 440 cells/mm3), reduction in viral load from172, 892.7(+189,040.8) to 7349.65(+22,526.4), at end of 6 months. Viral components in blood samples from 33% (24) of study subjects were undetectable at the end of 24 weeks of treatment. Overall adherence to ART among study subjects was good (90.41%) and the association between treatment adherence and effect of second line ART for 6 months was found to be statistically significant.

Conclusion: The present study revealed improvement in CD4 count, significant virological suppression and immunological recovery in patient started on second line ART following failing first line ART, who were followed for 6 months. Thus, strict adherence to the national policies on HIV testing, proper management of positive clients and full implementation of the “Treat All” policy, could help achieve, if not all, but at least the “95, 95, 95” target by 2024.

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