Clinical profile of HIV/AIDS patients seeking anti-retroviral therapy at District Hospital- A Longitudinal Study

Abstract

Introduction: Human immunodeficiency virus (HIV) is a lentivirus that causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections. HIV infection in humans is now pandemic. From 1981 to 2006, AIDS has killed more than 25 million people all over the world. Aims and objectives: 1) To study the clinical profile of HIV/AIDS patients seeking anti-retroviral therapy with respect to: a) CD4 count b) Opportunistic infections. c) Adherence Materials and Method: This present study was done between Jan 2010 and Feb 2011 among HIV/AIDS patients seeking ART at District hospital Belgaum. A total of 372 participants who were seeking ART, during January & February 2010 were included in the study and were followed up for one year. Predesigned and pretested questionnaire was used for data collection. Follow-up visits were done according to the NACO guidelines. Secondary data was collected from various records of ART centre. Statistical analysis was done by using percentages, chi square test and Paired t test. XI Results: In this present study majority 51.1% of the participants were females with 93.3% cases, Hindus in religion and 52.7% were unskilled workers. Illiterates were 43.8% with 66.4% participants in socio economic status class V. Majority 51.6% of them were rural residents and 48.9% of the participants stayed in nuclear family. In 93.5% participants’ heterosexual mode of transmission was seen. Majority i.e 79.3% were referred from VCTC.More than half 66.2% participants had multiple symptoms at ART initiation. More than half 50.5% had one or more opportunistic infections. Majority 58.6% of cases were in WHO clinical stage II and 91.3% cases had working functional status. For initiation of ART, 54.3% patients had both clinical symptoms & CD4 <250 cells as their eligibility criteria and majority 82.8% of patients were not using condoms.In 62.1% cases Zidovudine, Lamivudine & Nevirapine drug combination was started as initial regimen. 12 th Majority i.e 56.4%, 48.9% and 45.9%cases were seen in stage II at 1 month respectively. There is mean increase in CD4 count from baseline to 6 month and from baseline to 12 th month and 14.2% of patients had one or more opportunistic infections after initiation of ART. Majority of the study participants i.e 81.2%, 71.7% and 69.1% were working functional status at 1 respectively. Maximum patients i.e 74.2% adhered to ART after 1 proportion decreased at 12 th XII st , 6 th st and 12 st 6th and th th month month and later month to 63.9%. Anemia was the most common side effect reported in 37.9% patients , 3.5% cases stopped ART voluntarily and 17.2% deaths were reported . Majority i.e 70.4% of male cases & 82.6% of female cases had CD4 count ≥200 and 73.0% males & 90.3% female cases had CD4 count ≥200 at 6th &12 th month respectively. CD4 cell count improvement ≥200 was far better in age group <30 years compared to other age groups. Good prognosis was seen in non alcoholics & non smokers at 12 th month compared to alcoholics and smokers. At 6 month >95% adherence was observed in case of 83.0% males, 91.6% females compared to figures of 80-95% & <80% adherence. Conclusion: In this present study CD4 cell count improvement with ART was better in patients with good adherence. CD4 count improvement was good from baseline to 6 month and from baseline to 12 th month. Opportunistic infections were seen before and also after starting ART which are the main cause of morbidity and mortality. Decreased adherence to ART drugs was observed probably because of long duration of treatment and other reasons.