Main Article Content

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.

Abstract 172 | Pdf Downloads 83


1. India HIV Estimates 2021Fact Sheet National AIDS Control Organization(NACO),ICMR- National Institute ofMedicalStatisticshttps://naco.gov.in/sites/default/files/India%20HIV%20Estimates%202021%20_Fact%20Sheets__Final_Shared_24_08_2022.pdf
2. Kumar N, Krishnan S. Clinical, Immunological and Virological Profile of Patients with HIV Infection on Second Line Antiretroviral Therapy. IOSR Journal of Dental and Medical Sciences. 2016 sep;15(9):81-95.
3. Singh Jeetenkumar T,BabinaS , Nirmala T, Mobing. Profile of patients on second line antiretroviral therapy at RIMS, Imphal, Manipur. Int J Dent Health Sci. 2016;3(4):768-77.
4. UNAIDS,WHO(December2007)."2007AIDSepidemicupdate"(PDF).http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf.
5. Estill J, Ford N, Salazar-Vizcaya L, Haas AD, Blaser N, Habiyambere V. Second-line antiretroviral therapy in adults in sub-Saharan Africa up to 2030: a mathematical modelling study. Lancet HIV. 2016;3(3):132-39.
6. Health and Family Welfare Government of India. National Guidelines on Second line ART for adults and adolescents (NACO). 2021;106-10.
7. Modi JP, Kubavat A, Mundhava S, Lalwani U. A prospective study to evaluate efficacy of second-line antiretroviral therapy given to human immunodeficiency virus patients at Antiretroviral Therapy Plus Centre in India. Indian J Sex Transm Dis AIDS. 2019 jan-jun;40(1):51-6.
8. Ferradini L, Ouk V, Segeral O, Nouhin J, Dulioust A, Hak C. High efficacy of lopinavir/r-based second-line antiretroviral treatment after 24 months of follow up at ESTHER/Calmette Hospital in Phnom Penh, Cambodia. J Int AIDS Soc. 2011 Mar;14:14.
9. Achappa B, Madi D, Yousuff M, Rao S, Ramapuram. Clinical and Immunological Outcomes after Initiation of Second Line Antiretroviral Therapy in People Living with HIV. J of Clinical and Diagnostic Research. 2019 jan;13(1):08-10.
10. Thao VP, Quang VM, Wolbers M, Anh ND, Shikuma C, Farrar J. Second-Line HIV Therapy Outcomes and Determinants of Mortality at the Largest HIV Referral Center in Southern Vietnam. Medicine (Baltimore). 2015 Oct;94(43):1715.
11. Murphy RA, Sunpath H, Castilla C, Ebrahim S, Court R, Nguyen H, et al. Second-line antiretroviral therapy: long-term outcomes in South Africa. J Acquir Immune DeficSyndr. 2012 Oct;61(2):158-63.
12. Madec Y, Leroy S, Rey-Cuille MA, Huber F, Calmy A. Persistent Difficulties in Switching to Second-Line ART in Sub-Saharan Africa - A Systematic Review and Meta-Analysis. PLoS One. 2013;8(12
13. Choudhary N, Gomber S, Narang M. Clinico-immunological profile and outcome of antiretroviral therapy in HIV-positive children. Public Health Nutr. 2012 Aug;15(8):1442-45.
14. Zaunders JJ, Cunningham PH, Kelleher AD, Kaufmann GR, Jaramillo AB, Wright R, et al. Potent antiretroviral therapy of primary human immunodeficiency virus type 1 (HIV-1) infection: partial normalization of T lymphocyte subsets and limited reduction of HIV-1 DNA despite clearance of plasma viremia. The Journal of infectious diseases. 1999 Aug;180(2):320-29.
15. Ciaffi L, Koulla-Shiro S, Sawadogo A, Le Moing V, Eymard-Duvernay S, Izard S, et al. Efficacy and safety of three second-line antiretroviral regimens in HIV-infected patients in Africa. AIDS (London, England). 2015 Jul;29(12):1473.
16. Phillips AN, Lee CA, Elford J, Janossy G, Timms A, Bofill M, et al. Serial CD4 lymphocyte counts and the development of AIDS. Lancet 1991;337:389–92.
17. Mellors JW, Rinaldo CR Jr, Gupta P, White RM, Todd JA, Kingsley LA, et al. Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science 1996;272:1167–70.
18. Hammer SM, Hughes MD, Squires KE, Grimes JM, Demeter LM, Currier JS, et al. A controlled trial of two nucleoside analogues plus indinavir in persons with human immune deficiency virus infection and CD4 + T cell counts of 200 per cubic millimetre or less. N Engl J Med. 1997;337:725–33.
19. Gulick RM, Mellors JW, Havlir D, Eron JJ, Gonzalez C, McMahon D, et al. Treatment with indinavir, zidovudine and lamivudine in adults with human immune deficiency virus infection and prior antiretroviral therapy. N Engl J Med. 1997;337:734–39.
20. Markowitz M, Saag M, Powderly WG, Hurley AM, Hsu A, Valdes JM, et al. A preliminary study of ritonavir, an inhibitor of HIV-1 protease, to treat HIV-1 infection. N Engl J Med. 1995;333:1534-39.
21. Morgan D, Mahe C, Mayanja B, Okongo JM, Lubega R, Whitworth JA. "HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?" AIDS 16 (4):597–32.
22. Parienti JJ, Bangsberg DR, Verdon R, Gardner EM. Better adherence with once-daily antiretroviral regimens: A meta-analysis. Clin Infect Dis. 2009;48:484–88.
23. Amico KR, Harman JJ, Johnson BT. Efficacy of antiretroviral therapy adherence interventions: A research synthesis of trials, 1996 to 2004. J Acquir Immune DeficSyndr. 2006;41:285–97.
24. Haubrich RH, Little SJ, Currier JS, Forthal DN, Kemper CA, Beall GN. The value of patient-reported adherence to antiretroviral therapy in predicting virologic and immunologic response. California Collaborative Treatment Group. AIDS. 1999;13:1099–107.
25. Boyd MA. Improvements in antiretroviral therapy outcomes over calendar time. CurrOpin HIV AIDS. 2009;4:194–9.
26. Gilks CF, Crowley S, Ekpini R, Gove S, Perriens J, Souteyrand Y. The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings. Lancet. 2006;368:505–10.
27. National AIDS Control Organisation NACO India HIV Estimates 2021: Fact Sheet; Availableonline:http://naco.gov.in/sites/default/files/India%20HIV%20Estimates%202021%20_Fact%20Sheets__Final_Shared_24_08_2022_0.pdf Accessed on august 29, 2022.
28. SECOND-LINE REGIMENS - Antiretroviral Therapy for HIV Infection in Adults and Adolescents - NCBI Bookshelf. (n.d.). Retrieved August 27, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK138543/.
29. Sehgal PN. Shocking findings in Manipur. Health for the Millions. 1991 Aug;17(4):26-8.
30. Singh AK. AIDS in Manipur. Health for the millions. 1997;23(3):25-6.
31. Apoola A, Ahmad S, Radcliffe K. Primary HIV infection. International journal of STD & AIDS. 2002 Feb;13(2):71-80
32. Mitra AK, Hernandez CD, Hernandez CA, Siddiq Z. Management of diarrhoea in HIV-infected patients. International journal of STD & AIDS. 2001 Oct;12(10):630-39.
33. Sullivan M, Feinberg J, Bartlett JG. Fever in patients with HIV infection. Infectious Disease Clinics. 1996 Mar;10(1):149-65.
34. Baraki AG, Gezie LD, Zeleke EG, Awoke T, Tsegaye AT. Body mass index variation over time and associated factors among HIV-positive adults on second-line art in north-west Ethiopia: a retrospective follow-up study. BMJ open. 2019 Sep;9(9):e033393
35. Chakravarty J, Sundar S, Chourasia A, Singh PN, Kurle S, Tripathy SP, et al. Outcome of patients on second line antiretroviral therapy under programmatic condition in India. BMC infectious diseases. 2015 Dec;15(1):1-11.
36. Mugo CW, Shkedy Z, Mwalili S, Awoke T, Braekers R, Wandede D, et al. Modelling trends of CD4 counts for patients on antiretroviral therapy (ART): a comprehensive health care clinic in Nairobi, Kenya. BMC infectious diseases. 2022 Dec;22(1):1-2.
37. Langford SE, Ananworanich J, Cooper DA. Predictors of disease progression in HIV infection: a review. AIDS research and therapy. 2007 Dec;4(1):1-4.
38. Gardner EM, Maravi ME, Rietmeijer C, Davidson AJ, Burman WJ. The association of adherence to antiretroviral therapy with healthcare utilization and costs for medical care. Applied health economics and health policy. 2008 Jul;6(2):145-55.
39. Press N, Tyndall MW, Wood E, Hogg RS, Montaner JS. Virologic and immunologic response, clinical progression, and highly active antiretroviral therapy adherence. Journal of acquired immune deficiency syndromes (1999). 2002 dec;31:112-17.
40. Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of internal medicine. 2000 Jul 4;133(1):21-30.

Most read articles by the same author(s)