Immunological and virological response in HIV-1 infected patients receiving active antiretroviral therapy at a tertiary care center in Northern India
-
Arti Agrawal
,
Anshika Chawla
,
Astha .
,
Jitendra Kumar Doneria
,
Nitu Chauhan
,
Ayushi Gupta
,
Gargi Tyagi
,
Parul Garg
Abstract
Background and Objectives: Human Immunodeficiency Virus (HIV) remains a major global health challenge, with limited Indian data on factors influencing treatment outcomes. This study assessed immunological and virological responses and survival determinants among treatment-naïve HIV-1–positive adults.
Materials and Methods: A retrospective observational study was conducted at a tertiary care centre from May 2022 to April 2023. Adults (≥18 years) who initiated first-line ART (TDF + 3TC + DTG) between January 2019 and December 2020 with 24-month follow-up were included. Baseline demographics, CD4 count, viral load, and adherence were analysed using descriptive statistics and logistic regression.
Results: Of 452 screened patients, 355 were eligible. Mortality at 6, 12, and 24 months was 22%, 26.8%, and 29.9%, respectively, with overall survival of 70.1%. Baseline CD4 count, viral load, adherence, and ART initiation timing significantly influenced outcomes (p < 0.05). Patients with baseline between 200 to 350 had almost 7 times the odds of survival compared to those with <200 cells/µL. Early ART initiation (≤7 days) improved survival (3-fold) and viral suppression (2.4-fold), while adherence >95% was the strongest predictor of success. Older age and high viral load predicted poorer outcomes.
Conclusion: Early ART initiation, strict adherence, and favourable baseline markers significantly improved survival and suppression, supporting the “test-and-treat” approach and the UNAIDS 95-95-95 targets.
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25. Merati TP, Yunihastuti E, Wisaksana R, Kurniati N, Arlinda D, Karyana M, et al. A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality. BMC Infect Dis 2025; 25: 87.
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28. Nyaboke R, Ramadhani HO, Lascko T, Awuor P, Kirui E, Koech E, et al. Factors associated with adherence and viral suppression among patients on second-line antiretroviral therapy in an urban HIV program in Kenya. SAGE Open Med 2023; 11: 20503121231162354.
29. Moyo I, Mavhandu-Mudzusi AH, Lipeleke F, Sibindi M. Access to HIV prevention, treatment, and care services during COVID-19 by men who have sex with men in Zimbabwe: an interpretive phenomenological analysis study. PLoS One 2023; 18(4): e0281799.
30. Tusch E, Ryom L, Pelchen-Matthews A, Mocroft A, Elbirt D, Oprea C, et al. Trends in mortality in people with HIV from 1999 through 2020: a multicohort collaboration. Clin Infect Dis 2024; 79: 1242ß1257.
31. Gandhi RT, Landovitz RJ, Sax PE, Smith DM, Springer SA, Güntart HF, et al. Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society-USA Panel. JAMA 2025 Feb 18; 333: 609-628.
32. National AIDS Control Organisation (NACO). India HIV Estimations 2023: Technical Report. New Delhi: Ministry of Health and Family Welfare, Government of India: Available from: https://naco.gov.in/sites/default/files/India%20HIV%20Estimates%202023_Technical%20Report_Final_17%20DEC%202024%20%281%29.pdf (cited: June 13, 2025).
33. Sinha S, Abdul Samad S, Bansal G, Verma S, Sangle SA, Guha SK, et al. Survival of Persons Living With HIV/AIDS: A Multicentric Study From India. Curr HIV Res 2023; 21: 81-87.
2. Bayarsaikhan S, Jagdagsuren D, Gunchin B, Sandag T. Survival, CD4 T lymphocyte count recovery and immune reconstitution pattern during the first-line combination antiretroviral therapy in patients with HIV-1 infection in Mongolia. PLoS One 2021; 16(3): e0247929.
3. Solomon S, Solomon SS, Ganesh AK. AIDS in India. Postgrad Med J 2006; 82: 545-547.
4. Priyanka K, Nithyananda CM, Thomas RJ, Kudgi SA, Sanjay H. Gender-based early immunological response to antiretroviral therapy in HIV patients at a tertiary care hospital in coastal Karnataka. J Young Pharm 2023; 10: 74-77.
5. Manaye GA, Abateneh DD, Kebede KM, Belay AS. Immunological response during HAART and determinants of current CD4+ T-cell count among HIV/AIDS patients attending University of Gondar Referral Hospital, northwest Ethiopia. HIV AIDS (Auckl) 2020; 12: 295-306.
6. National AIDS Control Organisation. National Guidelines for HIV Care and Treatment. New Delhi: NACO; 2021. Available from: http://naco.gov.in/sites/default/files/National_Guidelines_for_HIV_Care_and_Treatment_2021.pdf (cited 2023 Jan 24)
7. World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: WHO; 2021. Available from:
https://www.who.int/publications/i/item/9789240031593 (cited 2023 Jan 27)
8. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd ed. Geneva: WHO; 2016. (cited 2023 Jan 27).
9. Tamrakar R, Tamrakar D, Shrestha S, Shrestha A. Virological and immunological status of people living with HIV undertaking highly active antiretroviral therapy. Kathmandu Univ Med J (KUMJ) 2019; 17: 217-222.
10. Kiros T, Taye A, Workineh L, Eyayu T, Damtie S, Hailemichael W, et al. Immuno-virological status and its associated factors among HIV-positive patients receiving highly active antiretroviral therapy at Delgi Primary Hospital, northwest Ethiopia, 2020/2021: a cross-sectional study. Heliyon 2022; 8(8): e10169.
11. Shet A, Neogi U, Kumarasamy N, DeCosta A, Shastri S, Rewari BB. Virological efficacy with first-line antiretroviral treatment in India: predictors of viral failure and evidence of viral resuppression. Trop Med Int Health 2015; 20: 1462-1472.
12. Tuboi SH, Schechter M, McGowan CC, Cesar C, Krolewiecki A, Cahn P, et al. Mortality during the first year of potent antiretroviral therapy in HIV-1-infected patients in 7 sites throughout Latin America and the Caribbean. J Acquir Immune Defic Syndr 2009; 51: 615-623.
13. Ren L, Li J, Zhou S, Xia X, Xie Z, Liu P, et al. Prognosis of HIV patients receiving antiretroviral therapy according to CD4 counts: a long-term follow-up study in Yunnan, China. Sci Rep 2017; 7: 10105.
14. Zhang G, Gong Y, Wang Q, Deng L, Zhang S, Liao Q, et al. Outcomes and factors associated with survival of patients with HIV/AIDS initiating antiretroviral treatment in Liangshan Prefecture, southwest China: a retrospective cohort study from 2005 to 2013. Medicine (Baltimore) 2016; 95(27): e3969.
15. Stanton AM, Boyd RL, O'Cleirigh C, Olivier S, Dolotina B, Gunda R, et al. HIV, multimorbidity, and health-related quality of life in rural KwaZulu-Natal, South Africa: a population-based study. PLoS One 2024; 19(2): e0293963.
16. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global AIDS Update 2024: The Urgency of Now – AIDS at a Crossroads. Geneva: UNAIDS; 2024.
17. Nguyen MX, Li C, Muessig K, Gaynes BN, Go VF. A systematic review of interventions for young men who have sex with men and young transgender women living with HIV. AIDS Behav 2024; 28: 1485-1511.
18. Mageda K, Leyna GH, Mmbaga EJ. High initial HIV/AIDS-related mortality and its predictors among patients on antiretroviral therapy in the Kagera region of Tanzania: a five-year retrospective cohort study. AIDS Res Treat 2012; 2012: 843598.
19. De La Mata NL, Kumarasamy N, Khol V, Ng OT, Van Nguyen K, Merati TP, et al. Improved survival in HIV treatment programmes in Asia. Antivir Ther 2016; 21: 517-527.
20. Moore DM, Awor A, Downing RS, Were W, Solberg P, Tu D, et al. Determining eligibility for antiretroviral therapy in resource-limited settings using total lymphocyte counts, hemoglobin and body mass index. AIDS Res Ther 2007; 4: 1.
21. De La Mata NL, Ly PS, Nguyen KV, Merati TP, Pham TT, Lee MP,et al. Loss to Follow-up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia From 2003 to 2013. J Acquir Immune Defic Syndr 2017; 74: 555-562.
22. Bai R, Du J, Lv S, Hua W, Dai L, Wu H. Benefits and Risks of Rapid Initiation of Antiretroviral Therapy: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 13: 898449.
23. Biset Ayalew M. Mortality and Its Predictors among HIV Infected Patients Taking Antiretroviral Treatment in Ethiopia: A Systematic Review. AIDS Res Treat 2017; 2017: 5415298.
24. Ojikutu BO, Zheng H, Walensky RP, Lu Z, Losina E, Giddy J, et al. Predictors of mortality in patients initiating antiretroviral therapy in Durban, South Africa. S Afr Med J 2008; 98: 204-208.
25. Merati TP, Yunihastuti E, Wisaksana R, Kurniati N, Arlinda D, Karyana M, et al. A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality. BMC Infect Dis 2025; 25: 87.
26. Uusküla A, Feelemyer J, Des Jarlais DC. HIV treatment, antiretroviral adherence and AIDS mortality in people who inject drugs: a scoping review. Eur J Public Health 2023; 33: 381-388.
27. Kadale P, Shidhaye P, Gurav S, Ap P, Ghate M. Enhanced adherence counselling outcomes among PLHIV with virological failure: Pune, India (2020–22). Chronic Illn 2024; 20: 405-412.
28. Nyaboke R, Ramadhani HO, Lascko T, Awuor P, Kirui E, Koech E, et al. Factors associated with adherence and viral suppression among patients on second-line antiretroviral therapy in an urban HIV program in Kenya. SAGE Open Med 2023; 11: 20503121231162354.
29. Moyo I, Mavhandu-Mudzusi AH, Lipeleke F, Sibindi M. Access to HIV prevention, treatment, and care services during COVID-19 by men who have sex with men in Zimbabwe: an interpretive phenomenological analysis study. PLoS One 2023; 18(4): e0281799.
30. Tusch E, Ryom L, Pelchen-Matthews A, Mocroft A, Elbirt D, Oprea C, et al. Trends in mortality in people with HIV from 1999 through 2020: a multicohort collaboration. Clin Infect Dis 2024; 79: 1242ß1257.
31. Gandhi RT, Landovitz RJ, Sax PE, Smith DM, Springer SA, Güntart HF, et al. Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society-USA Panel. JAMA 2025 Feb 18; 333: 609-628.
32. National AIDS Control Organisation (NACO). India HIV Estimations 2023: Technical Report. New Delhi: Ministry of Health and Family Welfare, Government of India: Available from: https://naco.gov.in/sites/default/files/India%20HIV%20Estimates%202023_Technical%20Report_Final_17%20DEC%202024%20%281%29.pdf (cited: June 13, 2025).
33. Sinha S, Abdul Samad S, Bansal G, Verma S, Sangle SA, Guha SK, et al. Survival of Persons Living With HIV/AIDS: A Multicentric Study From India. Curr HIV Res 2023; 21: 81-87.
| Files | ||
| Issue | Vol 18 No 1 (2026) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v18i1.20936 | |
| Keywords | ||
| HIV 1 CD4 HAART Immunological response Polymerase chain reaction Viral load | ||
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How to Cite
1.
Agrawal A, Chawla A, . A, Doneria J, Chauhan N, Gupta A, Tyagi G, Garg P. Immunological and virological response in HIV-1 infected patients receiving active antiretroviral therapy at a tertiary care center in Northern India. Iran J Microbiol. 2026;18(1):102-111.
