Chandy Sara, Singh Girija, Heylen Elsa, Gandhi Monica, Ekstrand Maria L
Department of Medicine, St John's Medical College and Hospital, Bangalore, India.
AIDS Care. 2011 May;23(5):569-77. doi: 10.1080/09540121.2010.525607.
Early identification and management of treatment failure on highly active antiretroviral therapy (HAART) is crucial in maintaining a sustained response to therapy in HIV infection. However, HIV viral load (VL) and resistance testing, and second-line HAART regimens, are unaffordable to many patients in India, leaving them with limited treatment options. Predictors and reasons for antiretroviral switching, therefore, are likely to differ in settings of varying resources. A one-year, observational study of patients receiving antiretroviral therapy was conducted in a private, non-profit hospital in Bangalore. This paper examines the predictors and consequences of antiretroviral treatment switching in this setting and explores reasons for switching in a subset of patients. Data on demographics, drug regimens, adherence, and physical and psychosocial outcomes were collected quarterly. Tests of VL and CD4 cell counts were performed every six months. One-third of the patients switched therapy during the study period. Baseline predictors of switching included lower CD4 cell counts and more physical symptoms. Contrary to studies in other settings, a high VL did not predict treatment switching, and only a minority of those experiencing drug failure were switched to second-line regimens. Both groups (switchers and non-switchers) improved significantly over time with respect to CD4 counts and psychological well-being, and showed a reduction in physical and depressive symptoms. Any differences between the groups were no longer significant at the end of the study, once we controlled for baseline levels. Clinical, policy, and research implications of these findings are discussed within the context of resource-limited settings.
早期识别并处理高效抗逆转录病毒治疗（HAART）中的治疗失败情况，对于维持HIV感染患者对治疗的持续反应至关重要。然而，HIV病毒载量（VL）检测、耐药性检测以及二线HAART方案，对印度的许多患者来说难以承受，这使得他们的治疗选择有限。因此，在资源不同的环境中，抗逆转录病毒治疗换药的预测因素和原因可能有所不同。在班加罗尔的一家私立非营利性医院，对接受抗逆转录病毒治疗的患者进行了为期一年的观察性研究。本文研究了该环境下抗逆转录病毒治疗换药的预测因素和后果，并探讨了部分患者换药的原因。每季度收集患者的人口统计学数据、药物治疗方案、依从性以及身体和心理社会方面的结果。每六个月进行一次VL检测和CD4细胞计数检测。在研究期间，三分之一的患者更换了治疗方案。换药的基线预测因素包括较低的CD4细胞计数和更多的身体症状。与其他环境中的研究相反，高病毒载量并不能预测治疗换药，而且只有少数经历药物治疗失败的患者更换为二线治疗方案。随着时间推移，两组患者（换药组和未换药组）在CD4细胞计数和心理健康方面均有显著改善，身体症状和抑郁症状也有所减轻。在我们对基线水平进行控制后，研究结束时两组之间的任何差异都不再显著。本文在资源有限的背景下讨论了这些研究结果的临床、政策和研究意义。
