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Journal of Basic and Clinical Physiology and Pharmacology

Editor-in-Chief: Horowitz, Michal

Editorial Board: Das, Kusal K. / Epstein, Yoram / S. Gershon MD, Elliot / Kodesh , Einat / Kohen, Ron / Lichtstein, David / Maloyan, Alina / Mechoulam, Raphael / Roth, Joachim / Schneider, Suzanne / Shohami, Esther / Sohmer, Haim / Yoshikawa, Toshikazu / Tam, Joseph

CiteScore 2016: 1.01

SCImago Journal Rank (SJR) 2016: 0.349
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Volume 30, Issue 2


Opportunistic infection at the start of antiretroviral therapy and baseline CD4+ count less than 50 cells/mm3 are associated with poor immunological recovery

Amod Tilak
  • Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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/ Smita Shenoy
  • Corresponding author
  • Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • Email
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/ Muralidhar Varma
  • Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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/ Asha Kamath / Amruta Tripathy
  • Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
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/ Ravi Sori
  • Department of Pharmacology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
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/ Kavitha Saravu
  • Department of General Medicine, Kasturba Medical College, Manipal, Manipal McGill Centre for Infectious Diseases (MACID), Manipal Academy of Higher Education, Manipal, Karnataka, India
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Published Online: 2019-03-22 | DOI: https://doi.org/10.1515/jbcpp-2018-0105



There is a dearth of studies assessing the efficacy and immunological improvement in patients started on antiretroviral therapy (ART) in India. This study was undertaken to assess the 2-year treatment outcomes in HIV-positive patients initiated on ART in a tertiary-care hospital.


After approval from the Institutional Ethics Committee, adult HIV-positive patients from a tertiary-care hospital, initiated on ART between January 2013 and February 2015, were included in the study. Data on clinical and immunological parameters were obtained from medical case records over a period of 2 years after initiation of therapy. Intention-to-treat analysis was done using a descriptive approach, using SPSS version 15 (SPSS Inc. Released 2006. SPSS for Windows, Version 15.0. Chicago, SPSS Inc.). A logistic regression analysis was done to assess the predictors for poor outcomes. A p-value <0.05 was considered statistically significant.


ART was initiated in 299 adult patients. At 1 and 2 years, the median (interquartile range) change in CD4+ cell count was 65 (39, 98) cells/mm3 and 160 (95, 245) cells/mm3. The change observed after 2 years of treatment initiation was statistically significant compared with that after 1 year. Three deaths occurred during the study period and 28 were lost to follow-up. Male sex, presence of at least one opportunistic infection at the start of therapy, and baseline CD4+ count <50 cells/mm3 were associated with poor immunological recovery.


With long-term treatment and regular follow-up, sustained clinical and immunological outcomes can be obtained in resource-limited settings.

Keywords: adherence; AIDS; CD4+ cell count; India; outcomes; tenofovir treatment


  • 1.

    Fettig J, Swaminathan M, Murrill CS, Kaplan JE. Global epidemiology of HIV. Infect Dis Clin 2014;28:323–37.CrossrefGoogle Scholar

  • 2.

    The use of antiretroviral drugs for treating and preventing HIV infection. 2016 [cited 2017 Sep 13]. Available at: http://apps.who.int/iris/bitstream/10665/208825/1/9789241549684_eng.pdf?ua=1.

  • 3.

    The human immunodeficiency virus and acquired immune deficiency syndrome (prevention and control) act, 2017. [cited 2017 Sep 22]. Available at: http://naco.gov.in/sites/default/files/HIV AIDS Act.pdf.

  • 4.

    Safrin S. Antiviral agents. In: Katzung BG, editor. Basic and Clinical Pharmacology. New Delhi: McGraw-Hill Education, 2015:835–65.Google Scholar

  • 5.

    Brennan AT, Shearer K, Maskew M, Long L, Sanne I, Fox MP. Impact of choice of NRTI in first-line antiretroviral therapy: a cohort analysis of stavudine vs. tenofovir. Trop Med Int Health 2014;19:490–8.CrossrefWeb of SciencePubMedGoogle Scholar

  • 6.

    Agu K, Ochei U, Oparah A, Onoh O. Treatment outcomes in patients receiving combination antiretroviral therapy in central hospital, Benin City, Nigeria. Trop J Pharm Res 2010;9:1–10.Google Scholar

  • 7.

    HIV treatment and care. 2017 [cited 2017 Sep 13]. Available at: http://apps.who.int/iris/bitstream/10665/255891/1/WHO-HIV-2017.22-eng.pdf?ua=1.

  • 8.

    Manohar HD, Shenoy S, Varma M, Kamath A, Malalur C, Bairy KL, et al. Antiretroviral therapy outcome in human immuno-deficiency virus infected patients in a tertiary care hospital. Int J Basic Clin Pharmacol 2016;5:616–22.Google Scholar

  • 9.

    Auld AF, Mbofana F, Shiraishi RW, Sanchez M, Alfredo C, Nelson LJ, et al. Four-year treatment outcomes of adult patients enrolled in Mozambique’s rapidly expanding antiretroviral therapy program. PLoS One 2011;6:e18453.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 10.

    Kipp W, Konde-Lule J, Saunders LD, Alibhai A, Houston S, Rubaale T, et al. Antiretroviral treatment for HIV in rural Uganda: two-year treatment outcomes of a prospective health centre/community-based and hospital-based cohort. PLoS One 2012;7:e40902.CrossrefWeb of ScienceGoogle Scholar

  • 11.

    Kumarasamy N, Venkatesh KK, Devaleenol B, Poongulali S, Mothi SN, Solomon S. Safety, tolerability and effectiveness of generic HAART in HIV-infected children in South India. J Trop Pediatr 2008;55:155–9.PubMedWeb of ScienceGoogle Scholar

  • 12.

    Zhang F, Dou Z, Ma Y, Zhao Y, Liu Z, Bulterys M, et al. Five-year outcomes of the China national free antiretroviral treatment program. Ann Intern Med 2009;151:241–51.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 13.

    Shah B, Walshe L, Saple DG, Mehta SH, Ramnani JP, Kharkar RD, et al. Adherence to antiretroviral therapy and virologic suppression among HIV-infected persons receiving care in private clinics in Mumbai, India. Clin Infect Dis 2007;44:1235–44.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 14.

    Kumarasamy N, Safren SA, Raminani SR, Pickard R, James R, Krishnan AS, et al. Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: a qualitative study. AIDS Patient Care STDS 2005;19:526–37.CrossrefPubMedGoogle Scholar

  • 15.

    Soriano V, Dona C, Rodríguez-Rosado R, Barreiro P, Lahoz JG. Discontinuation of secondary prophylaxis for opportunistic infections in HIV-infected patients receiving highly active antiretroviral therapy. Aids 2000;14:383–6.PubMedCrossrefGoogle Scholar

  • 16.

    Beatty GW. Immune reconstitution inflammatory syndrome. Emerg Med Clin 2010;28:393–407.CrossrefGoogle Scholar

  • 17.

    Lo CH, Lin TY. Immune reconstitution inflammatory syndrome. Respir Care 2014;59:e160–2.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 18.

    Surjushe AU, Jindal SR, Kamath RR, Saple DG. Immune reconstitution inflammatory syndrome. Indian J Dermatol Venereol Leprol 2006;72:410.PubMedCrossrefGoogle Scholar

  • 19.

    Bachani D, Garg R, Rewari BB, Hegg L, Rajasekaran S, Deshpande A, et al. Two-year treatment outcomes of patients enrolled in India’s national first-line antiretroviral therapy programme. Natl Med J India 2010;23:7–12.PubMedGoogle Scholar

  • 20.

    Huang P, Tan J, Ma W, Zheng H, Lu Y, Wang N, et al. Outcomes of antiretroviral treatment in HIV-infected adults: a dynamic and observational cohort study in Shenzhen, China, 2003–2014. BMJ Open 2015;5:e007508.Web of ScienceCrossrefPubMedGoogle Scholar

  • 21.

    Velen K, Lewis JJ, Charalambous S, Grant AD, Churchyard GJ, Hoffmann CJ. Comparison of tenofovir, zidovudine, or stavudine as part of first-line antiretroviral therapy in a resource-limited-setting: a cohort study. PLoS One 2013;8:e64459.CrossrefGoogle Scholar

  • 22.

    Mosha F, Muchunguzi V, Matee M, Sangeda RZ, Vercauteren J, Nsubuga P, et al. Gender differences in HIV disease progression and treatment outcomes among HIV patients one year after starting antiretroviral treatment (ART) in Dar es Salaam, Tanzania. BMC Public Health 2013;13:38.Web of ScienceCrossrefGoogle Scholar

  • 23.

    Antiretroviral Therapy Cohort Collaboration. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996–2006: collaborative analysis of 13 HIV cohort studies. Clin Infect Dis 2010;50:1387–96.PubMedWeb of ScienceGoogle Scholar

  • 24.

    Montessori V, Press N, Harris M, Akagi L, Montaner JS. Adverse effects of antiretroviral therapy for HIV infection. Can Med Assoc J 2004;170:229–38.Google Scholar

  • 25.

    Sullivan PS, Hanson DL, Chu SY, Jones JL, Ward JW, Adult/Adolescent Spectrum of Disease Group. Epidemiology of anemia in human immunodeficiency virus (HIV)-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project. Blood 1998;91:301–8.PubMedGoogle Scholar

  • 26.

    Fernandez-Fernandez B, Montoya-Ferrer A, Sanz AB, Sanchez-Nino MD, Izquierdo MC, Poveda J, et al. Tenofovir nephrotoxicity: 2011 update. AIDS Res Treat 2011;2011:1–11.CrossrefGoogle Scholar

  • 27.

    Bender MA, Kumarasamy N, Mayer KH, Wang B, Walensky RP, Flanigan T, et al. Cost-effectiveness of tenofovir as first-line antiretroviral therapy in India. Clin Infect Dis 2010;50:416–25.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 28.

    Evans D, Menezes C, Mahomed K, Macdonald P, Untiedt S, Levin L, et al. Treatment outcomes of HIV-infected adolescents attending public-sector HIV clinics across Gauteng and Mpumalanga, South Africa. AIDS Res Hum Retroviruses 2013;29:892–900.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 29.

    Kowalska JD, Kubicka J, Siwak E, Pulik P, Firląg-Burkacka E, Horban A. Factors associated with the first antiretroviral therapy modification in older HIV-1 positive patients. AIDS Res Ther 2016;13:2.CrossrefWeb of SciencePubMedGoogle Scholar

  • 30.

    Tsuchiya N, Pathipvanich P, Wichukchinda N, Rojanawiwat A, Auwanit W, Ariyoshi K, et al. Incidence and predictors of regimen-modification from first-line antiretroviral therapy in Thailand: a cohort study. BMC Infect Dis 2014;14:565.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 31.

    Kušić J, Mladenović M, Dimitrijević B, Aleksić B, Zec S, Jevtović D, et al. Treatment outcomes of first-line antiretroviral therapy in HIV-1-positive patients in Serbia. J Virus Erad 2016;2:32.PubMedGoogle Scholar

About the article

Corresponding author: Dr. Smita Shenoy, Additional Professor, Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India, Phone: +0820 2922365

Received: 2018-06-20

Accepted: 2018-10-27

Published Online: 2019-03-22

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Journal of Basic and Clinical Physiology and Pharmacology, Volume 30, Issue 2, Pages 163–171, ISSN (Online) 2191-0286, ISSN (Print) 0792-6855, DOI: https://doi.org/10.1515/jbcpp-2018-0105.

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