Outcomes of antiretroviral therapy in a northern Indian urban clinic.
OBJECTIVE
Antiretroviral therapy (ART) programmes have been successful in several countries. However, whether they would succeed as part of a national programme in a resource-constrained setting such as India is not clear. The outcomes and specific problems encountered in such a setting have not been adequately studied.


METHODS
We assessed the efficacy and functioning of India's national ART programme in a tertiary care centre in northern India. All ART-naive patients started on ART between May 2005 and October 2006 were included in the study and were followed until 31 April 2008. Periodic clinical and laboratory evaluations were carried out in accordance with national guidelines. Changes in CD4+ lymphocyte count, body weight and body mass index were assessed at follow-up, and the operational problems analysed.


METHODS
The setting was a tertiary care centre in northern India with a mixed population of patients, mostly of low socioeconomic status. The centre is reasonably well resourced but faces constraints in health-care delivery, such as lack of adequate human resources and a high patient load.


RESULTS
The response to ART in the cohort studied was comparable to that reported from other countries. However, the programme had a high attrition rate, possibly due to patient-related factors and operational constraints.


CONCLUSIONS
A high rate of attrition can affect the overall efficacy and functioning of an ART programme. Addressing the issues causing attrition might improve patient outcomes in India and in other resource-constrained countries.
Sharma
Surendra K
SK
Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India. sksharma@aiims.ac.in
Dhooria
Sahajal
S
Prasad
K T
KT
George
Ninoo
N
Ranjan
Sanjay
S
Gupta
Deepak
D
Sreenivas
Vishnubhatla
V
Kadhiravan
Tamilarasu
T
Miglani
Sunita
S
Sinha
Sanjeev
S
Wig
Naveet
N
Biswas
Ashutosh
A
Vajpayee
Madhu
M
D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019370:Observation; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D019037:Urban Health Services; D055815:Young Adult
D044966:Anti-Retroviral Agents