FACTORS DETERMINING THE PERSISTENCE OF THE VIRUS IN PATIENTS ON HAART – RESOURCE LIMITED COUNTRY SETTING-A PILOT STUDY.

Dr. Phanender.Ketha,   M.D.

Nodal Officer for control of AIDS, Project implementation plan, Phase II, National AIDS Control Organisation, India., Pulmonologist, Civil Assistant Surgeon, Government E.S.I.  Hospital, Visakhapatnam –5, Andhra Pradesh (India).

Background: Due to  various social factors, the HAART which is provided to the patients under the social security schemes, shows failure. The factors noted  are: At the patient’s end, the patient in fear of the social ostracism, changes the place of residence,get absconded from the duty or goes on unauthorized absence leading to failure to contribute money to the social security schemes, illiteracy & ignorance leading to improper dose and dosage, family withdrawal, poor health education facilities, social & interfamilial problems with the spouse,  social stigma due to a poor understanding by the society about the means   of transmission of HIV ,  patient’s inability to access the officers at the work to sort out certain issues regarding the documentation and the eligibility for medical benefit.At the healthcare setting, inadequate contribution of the patient to the social security scheme makes them ineligible for the medical benefits, patients come alone to the hospital with great difficulty without an attendant leading to difficulties in attending the emergencies, improper provision of the documents required for obtaining the medical benefit, etc. A clinical study of the treatment outcomes of Highly Active Anti-Retroviral Therapy in North Costal Andhra among thirty patients, HIV infected with low CD4 counts who are on Anti-retroviral therapy for a period of 1 ½ year, was done. Material and Methods: Initially screened with rapid test(tridot) followed by by western blot testing,CD4 counts (flow cytometry) evaluation and Viral Load estimations (RT PCR), HAART started appropriately and monitered periodically, evaluated for the results. Results: Overall results are that there is no mortality, there are two cases of clinical failure and considering the immunological failure in whom viral load was done (only 1/3 of the total patients). 66.6% were showing minimal viremia, 33.3% of cases showed viremia more than 20,000. Viral load done in 9 cases only, out of them 6 patients have viremia less than 20,000, one out of the 6 patients has undetectable viremia, 3 patients have viremia below 10,000, 2 patients have viremia in between 10,000 and 20,000. Conclusion: We conclude with guidelines for best practices as well as recommendations for future research.