Assessment of effectiveness in antiretroviral therapy with first-line regimens in HIV-infected patients

Abstract

Introduction: The HIV/AIDS infection in the Republic of Moldova is a priority public health problem. In the Republic of Moldova, after the onset of HIV/AIDS (1987) until 2011 were registered 7125 people infected with HIV. In 2011 were detected 721 new cases of HIV (13.87 to 100000 population), in 2010 to 704 cases. In 2011 were stricken with AIDS 420 persons (2010 - 290). The most frequent AIDS related conditions are pulmonary infection with Mycobacterium tuberculosis - 49,19%, esophageal candidiasis - 20% and the HIV fatigue syndrome (wasting syndrome) - 6,66%. International and national guidelines recommends that any patient with T-lymphocyte number CD4<350 cells/pl, should receive HAART (Highly Active Antiretroviral Therapy), whether it is asymptomatic, and the number of T-lymphocytes with CD4<200 cells/pml are with advanced HIV infection should receive immediate HAART. In addition, patients with CD4 between 350-500 cells/pl and HIV RNA>100.000 copies/ml should receive HAART. In the Republic of Moldova is provided universal access to HAART for people with HIV/ AIDS, which started to be applied since 2003. Currently in HAART are included 1606 people with HIV/ AIDS, out of which 771 people started HAART in 2011. Objectives: assessing clinical, immunologic and virologie evolution in naive HIV-infected patients, which received HAART 36 weeks (9 months). Materials and methods: We followed up 40 adult patients diagnosed with HIV/AIDS infection (average age 36,4 years), supervised in the specialized department and territorial cabinet of the Clinical Hospital of Infectious Diseases „Toma Ciorba”, of which, 19 (47,5%) patients initiated HAART with AZT(zid ovudine)+3TC(lamivudine)+EFV(efavirenz) (I regimen) and 21 (52,5%) patients with TDF(tenofovir)+ FTC(emtricitabine)+EFV(efavirenz) (II regimen), were evaluated during the first 36 weeks. Results: Out of the 40 patients who have initiated HAART, 28 (70%) patients were detected late with a number of CD4 < 350 cells/pl, out of which 18 (64,2%) patients were detected very late with a number of CD4 < 200 cells/pl. The most frequent opportunistic infections were present in the patients of our group, consisting of oropharyngeal candidiasis - 45%, pulmonary tuberculosis - 37,5%, Herpes Zoster - 7,5%, HIV fatigue syndrome (wasting syndrome) - 7,5% and HIV encephalopathy - 7,5%. At initiation of HAART, 75% of the investigated patients were in AIDS stage (A3 - 7,5%, B3 - 25%, C2 - 7,5% and C3 - 35%). The average CD4 value at HAART initiation was: I regimen - 214,11 ± 16,77 cells/pl and II regimen - 146,61±22,92 cells/pl (p<0.05). The average of viral load at HAART initiation was: I regimen - 1502,6±523,5 copies/ml and II regimen - 1623,5±794,5 copies/ml (p 0.05). When assessed at 12 weeks 13 patients had undetectable viral load (I regimen - 7 (36,8%), II regimen - 6 (28,6%)), at 24 weeks - 9 patients had undetectable viral load (1 -5 (26,3 %), II - 4 (19,04%)) and at 36 weeks - 9 patients had undetectable viral load (I - 7 (36,8%), II - 2 (9,5%)). The increase in CD4 was for I regimen to 222,11 ±32,45 cells/pi, maintaining at the same level with the baseline, and for II regimen - 200,42±43,36 cells/pi (to 53,8 cells/pi - of 1,36 times from baseline) (p 0.05). Conclusions: This study showed that: 1. Over two thirds (70%) of HIV/AIDS - infected patients were detected late, with the number of T-lymphocytes CD4<350 cells/pi, with or without AIDS related conditions, fact that leads to the need of improving HIV testing strategies. 2. Effectiveness of ART regimen applied appreciated in terms of virological response is higher for I regimen (3TC+EFV+AZT), and in terms of immunologic response is higher for II regimen (TDF+FTC+EFV). The dissociated virological and immunological response at HAART, registered for some of the patients, in many cases is the result of insufficient adherence to treatment, which increases the risk of progression of the disease.