title: Predictors of immunological failure and determinants of suboptimal CD4 testing among adults with HIV on first-line antiretroviral therapy in Andhra Pradesh, India, 2008-2011.
abstract: BACKGROUND
  Failure of first-line antiretroviral therapy (ART) results in high morbidity and mortality. We identified the predictors of immunological failure and suboptimal CD4 testing among adult people living with HIV (PLHIV) initiated on first-line ART.
  
  
  METHODS
  The cohort of PLHIV aged ≥ 15 years initiated on first-line ART in Hyderabad city, Andhra Pradesh state, in 2008 was followed-up until 31 December 2011 or until death and/or lost to follow-up (LFU). We estimated cumulative incidence of immunological failure. We explored socio-demographic, clinical, pharmacological and immunological factors to identify the predictors of immunological failure and determinants of suboptimal CD4 testing (<2 tests/year).
  
  
  RESULTS
  Among the 1431 PLHIV, 275 (19.2%) died and 263 (18.4%) were LFU. Of the remaining 893 (62.3%) patients on follow-up, 193 (21.6%) experienced immunological failure; these patients were more likely to be males, illiterate, with a history of pulmonary TB while on ART and taking stavudine-based regimen. Incidence of suboptimal testing ranged between 41 and 60% over 4 years of follow-up. Suboptimal CD4 testing among PLHIV was associated with history of TB prior to initiation of ART and stage 3 and 4 of HIV disease at enrollment.
  
  
  CONCLUSIONS
  There was low immunological failure rate but high incidence of suboptimal CD4 testing. The ART centre staff needs to be more vigilant about 6-monthly CD4 testing for timely detection of immunological failure and appropriate case management.
authors.affiliation: National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India SHARE India, Hyderabad, India.
authors.forename: Ramesh R
authors.initials: RR
authors.lastname: Allam
authors.affiliation: National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India mmurhekar@gmail.com.
authors.forename: Manoj V
authors.initials: MV
authors.lastname: Murhekar
authors.affiliation: National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India.
authors.forename: Tarun
authors.initials: T
authors.lastname: Bhatnagar
authors.affiliation: SHARE India, Hyderabad, India.
authors.forename: Chengappa K
authors.initials: CK
authors.lastname: Uthappa
authors.affiliation: SHARE India, Hyderabad, India.
authors.forename: C
authors.initials: C
authors.lastname: Nalini
authors.affiliation: National AIDS Control Organization, New Delhi, India.
authors.forename: B B
authors.initials: BB
authors.lastname: Rewari
authors.affiliation: National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India.
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Mehendale
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care; D016016:Proportional Hazards Models; D016019:Survival Analysis; D017211:Treatment Failure; D014397:Tuberculosis, Pulmonary / Q000276:immunology* / Q000401:mortality; D019562:Viral Load / Q000276:immunology*
chemical_list: D019380:Anti-HIV Agents
keywords: Andhra Pradesh; Antiretroviral therapy; First-line treatment; HIV; Immunological failure; India