EFFICACY OF ANTIRETROVIRAL THERAPY IN PATIENTS IN THE LATE STAGE HIV INFECTION
1Department of Infectious Diseases, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2City Clinical Infectious Disease Hospital, Dushanbe, Republic of Tajikistan
Objective: Assess the efficiency of highly active antiretroviral therapy (HAART) in patients in the late stage HIV infection
Methods: The effectiveness of HAART in 29 patients with late diagnosed HIV infection was assessed. Rapid testing and immunoenzyme testing were used to confirm the presence of HIV infection. The formulation of the clinical diagnosis was based on the clinical classification of HIV infection approved by WHO (2013). According to the National Clinical Protocol for HIV Treatment, approved in the Republic of Tajikistan, after treatment of opportunistic infections, all patients were assigned specific therapy. Evaluation of the effectiveness of therapy was carried out taking into account immunological and virological criteria, on changes in the level of CD4 lymphocytes and viral load before the onset of HAART and after 6 months after taking the drugs.
Results: All patients were examined and diagnosed with the IV clinical stage of HIV infection. Immunosuppression rate – the level of CD4 lymphocytes – at the time of the onset of HAART in all the study was less than 50 cells/μl. 16 (55.2%) patients received a HAART scheme consisting of tenofovir, emtricitabine, efavirenz (Viraday) in standard doses, 13 (44.2%) patients received abacavir, lamivudine, and lopinavir/ritonavir or atazanavir/ritonavir. During the study, 11 (37.9%) patients were fatal during 1-3 months of HAART. The causes of the fatal outcome were pulmonary tuberculosis, Kaposi sarcoma, multiple organ dysfunction syndrome, meningoencephalitis. In the surviving patients (n=18) after 6 months of the beginning of therapy, there was an increase in the level of CD4 lymphocytes on average by 129,4±5,2 cells/μl, of which only 8 (27.6%) patients had virological effect – the viral load level was less than 1000 copies/ml of blood.
Conclusions: Therapy was effective in 8 (27.6%) patients under investigation. The death of 37.9% patients is due to the late diagnosis of HIV infection, the onset of HAART with deep immunosuppression and the development of inflammatory immunity recovery syndrome.
Keywords: HIV infection, immunosuppression, CD4 lymphocytes, late diagnosis of HIV, HAART, viral load.
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Rakhmanov Erkin Rakhimovich , Doctor of Medical Sciences, Full Professor, Head of the Department of Infectious Diseases, Avicenna Tajik State Medical University ORCID ID: 0000-0003-0579-6223
Tsoy Victoria Nikolaevna , Assistant of the Department of Infectious Diseases, Avicenna Tajik State Medical University ORCID ID: 0000-0001-8416-1167
Yorova Sayora Kurbonalievna , Head of Division № 3, City Clinical Infectious Disease Hospital, Dushanbe ORCID ID: 0000-0002-3280-6469
Sharifzoda Turakhon Makhmud , Candidate of Medical Sciences, Infectious Disease Doctor, City Clinical Infectious Disease Hospital, Dushanbe ORCID ID: 0000-0002-7105-9267
Address for correspondence:
Rakhmanov Erkin Rakhimovich
Doctor of Medical Sciences, Full Professor, Head of the Department of Infectious Diseases, Avicenna Tajik State Medical University
734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139
Tel.: +992 (937) 853535