Dependence of АRT efficiency from the infection route in HIV infected patients

Abstract

The most rapid growth rate of the epidemic process of HIV in Ukraine is observed among injection drug users (IDUs). Substitution maintenance therapy (SMT) with methadone and buprenorphine significantly increases the patients’ maintenance in treatment due to increased adherence to antiretroviral therapy (ART), which is a mandatory component of comprehensive medical care for HIV-infected. The aim of our study was to determine the impact of SMT on the efficiency of ART for IDUs with HIV infection compared with patients infected through sexual contact. Materials and methods. The study included 95 patients with HIV that were divided into three groups. The first group included 33 IDUs patients who were treated with SMT. The second group included 32 IDUs patients without SMT. The third group included 30 patients with the sexual way of HIV infection. After the inclusion into the research all the patients were prescribed ART. Immunological examination and determination of viral load were carried out before the appointment of ART after 6 and 12 months during the treatment. Results and discussion. During the treatment with ART harder immunosuppression was recorded in the second group of patients, while the average viral load did not statistically differ in the research groups. After 6 months of the treatment the increase (P <0.05) of the number of CD4-lymphocytes was noted in all groups of patients, and the proportion of patients with full suppression of HIV in the first and the third groups was higher than in the second group, however this difference was not significant. After 12 months of the treatment, there was a further increase (P <0.05) of the absolute number of CD4-lymphocytes in the research groups, and in the virological efficiency of ART assessing a significantly higher (P <0.01) percentage was found in patients of the first and the third groups, who achieved the full viral suppression. It should be noted, that within 6-12 months of the treatment there was a decrease of the proportion of patients with virological efficiency of ART in the second group of patients. Conclusions. Immunological and virological efficiency of ART in the patients with HIV-infection IDUs received SMT after 12 months of the treatment didn`t differ from the group of patients infected by the sexual contact. There is an increase in the number of cases with virological failure among the patients with HIV IDUs who were not receiving SMT within 6 to 12 month of the treatment. Enabling patients to SMT programs increases the efficiency of the clinical examination and allows beginning of ART in time without severe immunosuppression, so it significantly improves the immunological efficiency of ART.

Keywords

• HIV infection
• anti-retroviral agents
• CD4-lymphocytes
• drug users