Antiretroviral treatment in resource-poor settings: A view from India

Context: The introduction of highly effective generic antiretroviral drugs at reduced cost has transformed the face of HIV/AIDS epidemic in developing countries like India. However, there is an urgent emphasis on developing and implementing guidelines for antiretroviral treatment monitoring by laboratory methods utilizing the available technologies in resource-limited settings. Aim: We studied the efficacy of antiretroviral treatment, adherence to therapy and motivation of patients for regular treatment monitoring by CD4 counts. Settings and Design: A longitudinal cohort study on an established cohort of 166 HIV-1-infected Indian individuals. Materials and Methods: Study subjects were followed up for the period from January 2002 to November 2006. Their clinical status and treatment regimen were recorded, and CD4 counts were performed at each visit. Statistical Analysis: Repeated-measures ANOVA was used to compute changes in median CD4 counts at each visit in the different treatment groups. Results: We observed a growing awareness and motivation for regular HIV disease monitoring among patients, accompanied by a trend of increasing median CD4 counts at all subsequent follow-up visits after initiation of antiretroviral treatment. Conclusions: The study gives an insight into the institutional efforts for the establishment of cohorts for longitudinal studies, which will help in designing effective treatment guidelines, thus providing impetus to the free public sector antiretroviral therapy program in India. Such formative research aims to fill the lacunae in the limited available data for the formulation of treatment-monitoring guidelines in resource-poor settings of developing countries like India.