|Year : 2003 | Volume
| Issue : 4 | Page : 274-276
The immunological and virological response in human immunodeficiency virus type-1 (HIV-1) infected Indian individuals on haart therapy: A one-year follow up study
R Kannangai , S Ramalingam , TS Vijayakumar , AA Vincent , OC Abraham , S Subramanian , P Rupali , D Mathai , MV Jesudason , G Sridharan
Departments of Clinical Virology, Christian Medical College, Vellore - 632 004, Tamil Nadu, India
Departments of Clinical Virology, Christian Medical College, Vellore - 632 004, Tamil Nadu, India
Currently, antiretroviral therapy has become more affordable even in developing countries and it is being used in India. Fifteen HIV-1 infected individuals, who were on highly active antiretroviral therapy (HAART), were followed up for an average period of one year. The plasma viral load and CD4+ T cell estimation done at mean intervals of 5 months and 11 months after initiation of therapy showed a good response to therapy in 14 (93%) individuals.
|How to cite this article:|
Kannangai R, Ramalingam S, Vijayakumar T S, Vincent A A, Abraham O C, Subramanian S, Rupali P, Mathai D, Jesudason M V, Sridharan G. The immunological and virological response in human immunodeficiency virus type-1 (HIV-1) infected Indian individuals on haart therapy: A one-year follow up study. Indian J Med Microbiol 2003;21:274-6
|How to cite this URL:|
Kannangai R, Ramalingam S, Vijayakumar T S, Vincent A A, Abraham O C, Subramanian S, Rupali P, Mathai D, Jesudason M V, Sridharan G. The immunological and virological response in human immunodeficiency virus type-1 (HIV-1) infected Indian individuals on haart therapy: A one-year follow up study. Indian J Med Microbiol [serial online] 2003 [cited 2020 Nov 24];21:274-6. Available from: https://www.ijmm.org/text.asp?2003/21/4/274/8043
Dramatic changes are occurring to optimize antiretroviral therapy. With antiretrovirals, at lowered cost, now available in the Indian market, therapy has become increasingly affordable. Potent regimens including drugs from different classes have shown prolonged suppression of human immunodeficiency virus (HIV) RNA in the plasma with an increase in the CD4+ T cell subsets. Majority of these reports are from the western countries. In this initial study, we report the response of 15 HIV-1 infected individuals who received highly active antiretroviral therapy (HAART), as observed by monitoring their plasma viral load and CD4+ T cell counts.
| ~ Materials and methods|| |
Fifteen treatment-naïve HIV-1 infected individuals who opted for HAART were followed up for an average period of 11 months after initiation of treatment. The clinical status of the individuals at the time of initiation of HAART as per CDC classification is as follows: 5 individuals (stage C); 5 individuals (stage B); 5 individuals (stage A).
CD4+ T cell count and HIV-1 viral load were measured before the commencement of the treatment (baseline value) and after 5 months and 11 months as follow up visit. After base line testing all the patients were started on triple drug combination antiretroviral drugs with two-nucleoside reverse transcriptase inhibitors in addition to either nevirapine or indinavir.
The quantitation of HIV-1 RNA in plasma was carried out by the Amplicor HIV-1 monitor test, version 1.5 (Roche Diagnostics, NJ, USA); this method estimates down to = 400 RNA copies / mL of plasma.
Estimation of CD4 / CD8+ T cell counts was carried out either by the Capcellia CD4 / CD8 whole blood kit (Bio-Rad USA) or by flowcytometry. The Capcellia CD4 / CD8 whole blood kit from BIORAD (USA), is an immunocapture ELISA based assay, where paramagnetic particles coated with anti-pan-T cell antibodies (anti-CD2) are used to capture T-lymphocytes. The captured T-lymphocytes are differentiated by use of specific monoclonal antibody conjugates and quantitation done in an ELISA format. Flowcytometry analysis was carried out with a FACScan flowcytometer (Becton Dickinson, CA, USA) using Simulset software. Wherever the flowcytometry value was available it was taken as the CD4 count. As the CD4 counts measured by Capcellia are higher than the flowcytometry a conversion factor of 0.54, (derived from our experience of comparing Flow Cytometry and Capcellia counts of about 200 samples) was used to correct the CD4 counts estimated by Capcellia.,
Data were subjected to ANOVA using Epi-info 6 software version 6.04 of CDC.
| ~ Results|| |
The study group consists of 15 individuals of whom 9 were males. The age range of the study group was 22 to 70 (mean ± SD; 41 ± 12 years). The clinical status of the individuals at the time of initiation of HAART as per CDC classification is as follows: 5 individuals (stage C); 5 individuals (stage B); 5 individuals (stage A). The mean baseline viral load and CD4 + T cells of these 15 individuals were 284187 RNA copies / mL of plasma and 109 cells / µL respectively. The first follow up visit was at a mean period of five months (range 3-11 months) while the second visit was 11 months (range 5-18 months) after initiation of treatment. Of the five who were in CDC stage C prior to treatment, one was in stage B during the first follow-up visit, two were in stage A during the first follow-up visit and thereafter, while the other two were in stage C for three follow-up visits and thereafter in stage A. All five of those in stage B pre-treatment were in stage A during the first follow-up visit and remained so during the entire period of study. The other five were consistently in stage A from the first to the last visit. The mean viral loads showed a significant (p <0.0000) decrease to 537 and 511 RNA copies/ mL during the first and second follow-up visits, respectively. The mean + SD CD4+ cell count during the two follow-up visits showed a significant (p =0.0012) increase to 237 ± 144/µL (first visit) and 278 ± 131/µL (second visit). The median decrease from baseline HIV-1 viral RNA copies and the median increase from baseline CD4+ T cell counts are shown in [Figure - 1] and [Figure:2] respectively.
| ~ Discussion|| |
Access to antiretroviral drugs is increasing as the prices of the drugs are on the decline. The use of HAART has reduced the HIV related mortality and morbidity to a substantial extent. It is now recognized that after the initiation of HAART the antiviral response can be seen at least by 6 weeks with a reduction in plasma HIV viral load by one log and after 24 weeks reaching undetectable levels in the plasma., In the study reported here all except two patients showed RNA levels below the detection limit of the kit (400 copies/mL) during the first follow-up visit. All individuals except one showed an increase in CD4 cell count as well. However, in that one patient, the RNA level was below the detection limit at that particular visit though the CD4+ cell count was lower than baseline value. While 14 individuals showed complete suppression of virus by HAART at the second follow-up visit, one individual who showed undetectable amount of HIV viral RNA during the first follow-up visit showed 2073 copies of RNA / mL in the second visit and 1804 copies of RNA / mL during the subsequent visit (rebound).
In a recent clinical trial it was established that early initiation of anti retroviral drugs during chronic asymptomatic period does have a statistically significant benefit. The efficacy of the treatment depends on the regimen of drug used, patient adherence, drug interactions, frequency of drug adverse effects and the strain of virus. The immunological and virological response seen in our study is comparable to western cohorts though a different HIV-1 subtype (subtype C) is prevalent in India. Longitudinal follow up of such cohorts would help assess prolonged suppression of viraemia or any emergence of drug resistance.
| ~ References|| |
|1.||Serchuck LK, Welles L, Yarchoan R. Antiretroviral treatment for HIV infection. In TC Merigan Jr, JG Bartlett, D Bolognesi (Eds.), Textbook of AIDS medicine 2nd ed. (Williams & Wiilkins Publishers, Baltimore) 1999;780-806. |
|2.||Cooper DA, Phanuphak P, Sendi PP, et al. Potential benefit and limitations of a broad access to potent antiretroviral therapy in developing countries. Expert Opin Investig Drugs 2002:11(9):1303-1313. |
|3.||Hammer S. Stratgey and use of antiretroviral agents in combination. In T.C. Merigan Jr, JG Bartlett and D Bolognesi (Eds), Textbook of AIDS medicine 2nd ed. Williams & Wiilkins Publishers, Baltimore, 1999:872-884. |
|4.||Center for Disease Control. Revised classification system for HIV infection and expanded surveillance case definitions for AIDS among Adolescents and adults. MMWR RR-17:41:1-19. |
|5.||Kannangai R, Prakash KJ, Ramalingam S, et al. Peripheral CD4+/CD8+ T-lymphocyte counts estimated by an immunocapture method in the normal healthy south Indian adults and HIV seropositive individuals. J Clin Virol 2000;17:101-108. |
|6.||Kannangai R, Ramalingam S, Jesudason MV, et al. Correlation of CD4+ T cell counts estimated by an immunocapture technique (Capcellia) with viral loads in HIV seropositive individuals. Clin Diagn Lab Immunol 2001;8:1286-1288. |
|7.||Palella FJ, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Eng J Med 1998;338:853-860. |
|8.||Gulick RM, Mellors JW, Havlir D, et al. Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. N Engl J Med 1997;337(11):734-739. |
|9.||Gulick RM, Mellors JW, Havlir D, et al . 3-year suppression of HIV viremia with indinavir, zidovudine, and lamivudine. Ann Intern Med 2000;133(1):35-39. |
|10.||Opravil M, Ledergerber B, Hansjakob F, et al. Clinical efficacy of early initiation of HAART in patients with asymptomatic HIV infection and CD4 cell count > 350 x 106 / L. AIDS 2002;16:1371-1381. |
|11.||Gadkari DA, Moore D, Sheppard HW, et al. Transmission of genetically diverse strains of HIV-1 in Pune, India. Indian J Med Res 1998;107:1-9. |