Infectious Diseases

doi: 10.25005/2074-0581-2019-21-2-232-237
EFFICACY OF ANTIRETROVIRAL THERAPY IN PATIENTS IN THE LATE STAGE HIV INFECTION

E.R. Rakhmanov1, V.N. Tsoy1, S.K. Yorova2, T.M. Sharifzoda2

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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References
  1. Belyakov NA. Virus immunodefitsita cheloveka – meditsina [Human Immunodeficiency Virus – Medicine]. Saint-Petersburg, RF: Baltiyskiy meditsinskiy obrazovatel’nyy tsentr; 2011. 656 p.
  2. Hoffmann K, Rokshtro YuK. (red.) VICH 2014/2015 [HIV 2014/2015]. Hamburg, Bonn, Germany: Medizin Fokus; 2015. 924 p.
  3. Svodnoe rukovodstvo po ispol’zovaniyu antiretrovirusnykh preparatov dlya lecheniya i profilaktiki VICH-infektsii. Vtoroe izdanie [Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. 2nd ed.]. VOZ: 2016. 429 p.
  4. Martin A, Bloch M, Amin J, Baker D, Cooper DA, Emery S, et al. Simplification of antiretroviral therapy with tenofovir-emtricitabine or abacavirLamivudine: a randomized, 96-week trial. Clin Infect Dis. 2009;49(10):1591- 601.
  5. Pilcher CD, Ospina-Norvell C, Dasgupta A, Jones D, Hartogensis W, Torres S, et al. The effect of same-day observed initiation of antiretroviral therapy on HIV viral load and treatment outcomes in a US public health setting. Journal of Acquired Immune Deficiency Syndromes. 2017;74(1):44-51.
  6. Lin KY, Cheng CY, Li CW, Yang CJ, Tsai MS, Liu CE, et al. Trends and outcomes of late initiation of combination antiretroviral therapy driven by late presentation among HIV-positive Taiwanese patients in the era of treatment scale-up. PloS ONE. 2017;12(6):e0179870.
  7. Nakagawa F, Lodwick R, Smith C, Costagliola D, van Sighem A, Ledergerber B, et al. Factors associated with short-term changes in HIV viral load and CD4 R cell count in antiretroviral-naive individuals. AIDS. 2014;28(9):1351- 6.
  8. Boyer S, March L, Kouanfack C, Laborde-Balen G, Marino P, Aghokeng AF, et al. Monitoring of HIV viral load, CD4 cell count, and clinical assessment versus clinical monitoring alone for antiretroviral therapy in low-resource settings (Stratall ANRS 12110/ESTHER): a cost-effectiveness analysis. The Lancet Infectious Diseases. 2013;13(7):577-86
  9. Trickey A, May MT, Vehreschild JJ, Obel N, Gill MJ, Crane HM, et al. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. The Lancet HIV. 2017;4(8):e349-e356
  10. Azovtseva OV, Trofimova TC, Arkhipov GS, Ogurtsova SV, Panteleev AM, Belyakov NA. Letal’nye iskhody u bol’nykh s VICH-infektsiey, paralleli s adekvatnost’yu diagnostiki, dispanserizatsii i lecheniya [Lethal outcomes in patients with HIV infection, parallels with adequacy of diagnostics, dispenser and treatment]. VICH infektsiya i immunosupressii. 2018;10(3):90-101.
  11. Belyakov NA, Trofimova TN, Boeva EV, Semyonova MD. Sovremennoe zvuchanie problem sindroma vosstanovleniya immuniteta na fone ARVT [The present day perception of the problem of immune restoration of upon ART]. VICH infektsiya i immunosupressii. 2018;10(2):14- 27.
  12. Zheng Z, Lin J, Lu Z, Su J, Li J, Tan G, et al. Mortality risk in the population of HIV positive individuals in Southern China: A cohort study. PLoS ONE. 2019;14(2):e0210856. Available from: http://dx.doi.org/doi.org/10.1371/ journal.pone.0210856.
  13. Cid-Silva P, Margusino-Framiñán L, Balboa-Barreiro V, Pernas-Souto B, Mena-De-Cea Á, Martín-Herranz I, et al. Late HIV diagnosis but earlier antiretroviral treatment initiation in Northwest Spain: Impact of current treatment guidelines. Journal of the International Association of Providers of AIDS Care (JIAPAC). 2019;18:1-5. Available from: http://dx.doi.org/doi. org/10.1177/2325958218821940.
  14. Ribeiro LCS, Giami A, Freitas MIF. Representations of people living with HIV: influences on the late diagnosis of infection. Revista da Escola de Enfermagem da USP. 2019;53:e03439. Available from: http://dx.doi. org/10.1590/S1980-220X2018009703439.
  15. Tursunov RA. Etapy stanovleniya sistemy epidnadzora za VICH-infektsiey v Respublike Tadzhikistan [Stages of establishing a system of epidemiological surveillance of HIV infection in the Republic of Tajikistan]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;1:100-6.
  16. Rafiev KhK, Nurov RM, Rakhmanova AG, Goncharov AE, Aslanov BI. Razvitie epidemicheskogo protsessa VICH-infektsii v Respublike Tadzhikistan [Development of HIV epidemic in Tajikistan]. VICH infektsiya i immunosupressii. 2014;6(2):118-23.
  17. Tursunov RA, Rafiev KhK, Nurov RM, Rakhmanov ER, Sharipov TM. Opportunisticheskie infeкtsii u VICH-infitsirovannykh bol’nykh v Respublike Tadzhikistan [Opportunistic infections in HIV-infected patients in Tajikistan]. Vestnik Avitsenny [Avicenna Bulletin]. 2012;3:123-6.
  18. Yakovlev A, Musatov VB, Savchenko MA. Prichiny letal’nykh iskhodov u VICHinfiysirovannykh patsientov, poluchayushchikh antiretrovirusnuyu terapiyu [Causes of death amoung HIV infected patients receiving antiretroviral therapy]. VICH infektsiya i immunosupressii. 2015;7(1):84–88.
  19. Zakharova NG, Dvorak SI, Plavinski SL. Prichiny neblagopriyatnykh iskhodov u bol’nykh s VICH-infektsiey, prinimavshikh VAART. Chast’ 1 [The causes of unfavorable out-comes amoung patients taking HAART. Part 1]. VICH infektsiya i immunosupressii. 2015;7(3):48-54.
  20. Sharma SK, Soneja M. HIV & immune reconstitution inflammatory syndrome (IRIS). Indian J Med Res. 2011;134(6):866-77.
  21. Matievskaya NV. Vospalitel’nyy sindrom vosstanovleniya immuniteta u VICH-infitsirovannykh patsientov: faktory riska, klinicheskie proyavleniya, iskhody, profilaktika [Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients: risk factors, clinical features, outcomes, prevention]. Vestnik Baltiyskogo Federal’nogo universiteta im. I. Kanta. Seriya: estestvennye i meditsinskie nauki. 2012;7:44-51.
  22. Azovtseva OV, Arkhipov GS, Arkhipova EI. Sravnitel’nyy analiz prichin smertnosti VICH-infitsirovannykh bol’nykh [A comparative analysis of causes of death in HIV infected patients]. VICH infektsiya i immunosupressii. 2015;7(4):86-91. Available from: http://dx.doi.org/10.22328/2077-9828- 2015-7-4-86-91.
  23. Leonova ON, Stepanova YV, Belyakov NA. Tyazhyolye i komorbidnye sostoyaniya u bol’nykh s VICH-infektsiey [Severe and comorbid conditions in HIV patients: an analysis of adverse outcomes]. VICH infektsiya i immunosupressii. 2017;9(1):55-62. Available from: http://dx.doi. org/10.22328/2077-9828-2017-9-1-55-62in HIV patients: an analysis of adverse outcomes]. VICH infektsiya i immunosupressii. 2017;9(1):55-62. Available from: http://dx.doi. org/10.22328/2077-9828-2017-9-1-55-62
  24. Oleynik AF, Fazylov VH, Beshimov AT. Kliniko-immunologicheskie i virusologicheskie pokazateli effektivnosti antiretrovirusnoy terapii [Clinical, immunological and virological indicators of antiretroviral therapy efficiency]. Vestnik Rossiyskogo gosudarstvennogo meditsinskogo universiteta. 2017;1:59-65.
  25. Jones LE, Perelson AS. Transient viremia, plasma viral load, and reservoir replenishment in HIV-infected patients on antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes. 2007;45(5):483-93. Available from: http://dx.doi.org/10.1097/QAI.0b013e3180654836.

Authors informations:

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

E-mail: erkin_rahmonov@mail.ru

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