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Treatment switching in South Indian patients on HAART: What are the predictors and consequences

Content Provider	PubMed Central
Author	Chandy, Sara Singh, Girija Heylen, Elsa Gandhi, Monica Ekstrand, Maria L.
Abstract	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 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 viral load 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 viral load 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 showed a reduction in physical and depressive symptoms and psychological well-being, and 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.
Related Links	http://dx.doi.org/10.1080/09540121.2010.525607
Ending Page	577
Page Count	9
Starting Page	569
File Format	PDF
ISSN	09540121
e-ISSN	13600451
Journal	AIDS care
Issue Number	5
Volume Number	23
Language	English
Publisher Date	2011-05-01
Access Restriction	Open
Subject Keyword	Public Health, Environmental and Occupational Health Health(social science) Social Psychology Research in Higher Education
Content Type	Text
Resource Type	Article
Subject	Public Health, Environmental and Occupational Health Health (social science) Social Psychology

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