Two-year treatment outcomes of patients enrolled in NACO's 1st line ART programe

July 10, 2010

Two-year treatment outcomes of patients enrolled in India's national first-line

antiretroviral therapy programme

DAMODAR BACHANI, RENU GARG, BHARAT B. REWARI, LEA HEGG,

SIKHAMANI RAJASEKARAN, ALAKA DESHPANDE, K. V. EMMANUEL,

POLIN CHAN, K. SUJATHA RAO

ABSTRACT

Background. We aimed to analyse treatment outcomes of patients receiving

first-line antiretroviral therapy (ART) through the national AIDS control

programme of India.

Methods. Using routinely collected programme data, we analysed mortality, CD4

evolution and adherence outcomes over a 2-year period in 972 patients who

received first-line ART between 1 October 2004 and 31 January 2005 at 3

government ART centres. regression analysis was used to identify independent

predictors of mortality.

Results. Of the 972 patients (median age 35 years, 66% men), 71% received the

stavudine/lamivudine/nevirapine regimen. The median CD4 count of enrolled

patients was 119 cells/cmm (interquartile range [iQR] 50–200 cells/ cmm) at

treatment initiation; 44% had baseline CD4 count <100 cells/cmm.

Of the 927 patients for whom treatment outcomes were available, 71% were alive

after 2 years of treatment.

The median increase in CD4 count was 142 cells/ cmm (IQR 57–750 cells/cmm;

n=616) at 6 months and 184 cells/cmm (IQR 102–299 cells/cmm; n=582) at 12 months

after treatment.

Over 2 years, 124 patients (13%) died; the majority of deaths (68%) occurred

within the first 6 months of treatment. Those with baseline CD4 count <50

cells/cmm were significantly more likely to die (adjusted hazard ratio 2.5, 95%

confidence interval 1.3–3.2) compared with patients who had baseline CD4 count

>50 cells/cmm.

Over the 2-year period, 323 patients (35%) missed picking up their monthly drugs

at least once and 147 patients (16%) were lost to follow up.

Conclusion. Survival rates of HIV-infected patients on first-line ART in India

were comparable with those from other resource-limited countries. Most deaths

occurred early and among patients who had advanced disease. Earlier initiation

of HIV treatment and improving long term treatment adherence are key priorities

for India's ART programme.

Natl Med J India 2010;23:7–12

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