Academic journal article Central European Journal of Public Health

Outcome of Antiretroviral Treatment in Patients with Aids Monoinfection and Those Co-Infected with Hepatitis B and C Viruses and Tuberculosis in Ukraine

Academic journal article Central European Journal of Public Health

Outcome of Antiretroviral Treatment in Patients with Aids Monoinfection and Those Co-Infected with Hepatitis B and C Viruses and Tuberculosis in Ukraine

Article excerpt

SUMMARY

Antiretroviral therapy reduces AIDS morbidity and mortality as well as decreases HIV transmission by reducing the viral load (VL). We aimed to determine the rate of immunological and virological failure that reflects antiretroviral treatment (ART) effectiveness among the patients of the Kyiv City AIDS Centre and may lead to ART switch in the future. In 59% of patients the prescribed ATR regimen was regarded as successful, in 37% as unsuccessful and 4% of patients were excluded for lacking sufficient follow-up time. Among the cases of unsuccessful ART, the largest part of patients was experiencing secondary immunological failure, on the second place was primary immunological failure. The temporal distribution of primary and secondary failures was also defined. It was shown that the number of patients with treatment failure increases steadily. Drug resistance testing is able to reduce the number of unsuccessful ART regimens, but such testing is not a part of the routine testing in Ukraine.

Key words: antiretroviral treatment, immunological failure, AIDS monoinfection, hepatitis, tuberculosis

INTRODUCTION

According to the 2009 AIDS Epidemic Update (1), the number of people living with HIV worldwide reached 33.4 million in 2008, and continues to grow. Among European countries, Ukraine is experiencing especially severe and growing national epidemic. With adult HIV prevalence higher than 1.6%, Ukraine has the highest infection level reported in Europe (2). By 1 January 2009, the total number of HIV-infected individuals registered in Ukraine was 91,717, among them 10,410 AIDS patients (3). In addition, such infections as tuberculosis (TB), Hepatitis B (HBV) and C (HCV) further complicate the course of disease. The prevalence of tuberculosis in Ukraine reached 47,000 cases in 2009, and the TB/HIV co-infection rate was 19 cases per 100 TB patients (4). Around 1 million people are currently infected with HCV in Ukraine, with the prevalence among people living with HIV of 53.3%, and those infected with tuberculosis of 46.7% (5). The data about HBV distribution in Ukraine are scarce, but the prevalence reaches more than 2% of population (6). In such circumstances ART not only reduces AIDS morbidity and mortality, but it is also believed that improved treatment access and successful ART could help decrease HIV transmission by reducing the viral load (3).

However, the beneficial impact of antiretroviral therapy is considerably restricted by the ability of HIV to mutate and reproduce itself in the presence of antiretroviral drugs, which further leads to the development of drug resistance (7-9). Despite the fact that long-term ART is toxic and associated with many metabolic disorders (10), interrupting ART leads to a rapid viral rebound, attributed to the persistence of latently-infected cellular reservoirs in some cell populations, such as macrophages, monocytes and T-lymphocytes (11).

Due to high genetic variability of HIV, mutations occur in viral genome at a high rate. The resultant hybrid genomes may create drug-resistant strains that emerge and predominate in the presence of a certain drug regardless of their initial proportion in the HIV population, whereas other (sensitive) strains are suppressed. Either a single-point mutations or an accumulation of such mutations that provide a survival advantage may lead to the resistance to a specific drug or a specific drug combination, which is an increasingly recognized problem (9, 12, 13).

Like in other resource-limited countries, clinicians do not make individualized regimen decisions when prescribing ART in Ukraine, and regimen selection is regulated by the protocols of the Ministry of Public Health guided by the WHO recommendations. It is generally accepted that inefficient ART is associated with immunological and virological failure and clinical progression of HIV infection. The efficiency of ART is characterized by measurements of the plasma VL as well as CD4+ blood count without resorting to the third criterion - clinical failure. …

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