Life expectancy of people who are infected with Human immune deficiency virus are most important in providing valuable information to patients regarding their prognosis in long term, in estimating the future costs associated with HIV related care, in predicting the probable future socioeconomic and demographic impact of HIV.(1).

The life anticipation gauges of HIV positive grown-ups in developing countries have been distributed, and numerous of these thinks about have appeared critical enhancements in life hope after the presentation of highly active antiretroviral treatment (cART) (2)

Studies have appeared diminishing rates of AIDS related death compared to non-AIDS related death since the introduction of cART & described a require for increasing eye on chronic disease treatment & wellbeing advancement (3)

There's confirmation with immunologic strength with age and age at cART treatment has been connected with the rate and degree of immunologic change. The impacts of aging on survival hence got to be considered in expansion to the impacts of expanded length of infection. (4) However studies of overall life expectancy in HIV positive people are often limited by insufficient data in old age groups were rapid increase in general individual mortality are seen. There remains a ought to great get it of long term survival in elderly HIV+ve individuals after delayed cART. (5) There's expanded chances of getting HIV in people who have sex men with men, for ladies the hetero transmission rate is around 90%. (6)

Sticking to treatment & an imperceptible HIV RNA viral stack are most critical indicators of mortality but there are male & female contrasts that make these endpoints troublesome to victory in defenseless individuals. (7) For 20 yrs, combination antiretroviral treatment (cART) has been the standard approach to treating HIV-1 contamination in Europe and North America. (8) The primary ART regimens were second rate to those as of now accessible, which superior smother HIV replication, are less poisonous, and have higher hereditary obstructions to resistance, diminished pill burden (frequently one a day), and less side-effects.(9)

Therefore, individuals living with HIV who begun c ART more as of late might have progressed survival compared with those treated prior within the ART era. (10)

The WHO gauges that almost 3 million individuals were receiving cART in lower and moderate income nations by the conclusion of 2007, a 7.5- fold increment amid the past four years. (11) Utilizing information from a arrange of ART treatment programs in resource limited settings, we found that on normal 21% of patients had been misplaced to programmes in the primary 6 months after beginning ART. So also, a systematic review of ART programs in sub-Saharan Africa found that about 40% of patients were misplaced at 2 yrs, with huge variety in retention rates between programmes. (12)

AIM:

“To study the Clinico-epidemiological Profile of people living with HIV (PLHIV) on minimum 10 years of Combination ARV therapy (c ART)”

This is a Descriptive and Cross sectional study. Clinical epidemiological profile was collected from patient file available in ART centre as mentioned in annexure 1 was assessed by WHO questionnaire as mentioned in annexure 2.

Study Setting:

Out/inpatient patients of hospitals affiliated to Kasturba medical college, Mangalore i.e.

• “KMC hospital, Attavar”
• Wenlock Hospital, Mangalore

Inclusion criteria:

1. HIV/AIDS Positive Regardless of language, age, sex, nationality, religion and race for a period of ten years
2. On cART
3. Infection Confirmed by ELISA OR WESTERN BLOTTING
4. Age >18yrs
5. Willing to give informed consent

Exclusion criteria:

1. Age <18

Data Collection Methodology:

Study was initiated after approval was obtained from the institutional ethics committee. Study related procedures and enrolment of eligible subjects was done only after obtaining an informed consent from the patient. Confidentiality of patient’s details was maintained at all levels using appropriate coding.

Subjects fulfilling inclusion & exclusion criteria were enrolled in to the study. 300 records were collected from ART centre KMC Attavar ID clinic ART centre who are on ART for A minimum of ten years.

Table 1 Shows age distribution in PL HIV

In age distribution 18 to 20 years are 2%, 21 to 30 are 15%, 31 to 40 50.3%, 41 to 50 are 24.3%, 51 to 60 are 6.7%, 61 to 70 are 1.3% and 71 to 80 are 1%. This indicates main age group affected is between 31 to 40 years indicating young age group is mainly affected.

Table 2 Shows frequency of HIV cases in association with sex of the individuals

70% were male patients and 30% were female indicating more number of HIV cases in male population.

Table 3 Shows frequency of HIV cases associated with mode of transmission

93.3% of HIV patients were heterosexual, 2 % were homosexual, 4.7% was mother to child transmission.

Table 4 Shows frequency of HIV cases in association with spouse infected status

SPOUSE STATUS

42% of HIV+ve patients had reactive or HIV +ve spouses and 29% had non-reactive spouses whereas it was not applicable for28.7 % (unmarried /widowed)

Table 5 shows frequency of different opportunistic infections in HIV+ve patients.

Opportunistic Infections

53.3% of HIV +ve cases did not have any opportunistic infections. i.e. approximately 47% had opportunistic infections.16.7% of HIV +ve cases had pulmonary Tuberculosis followed by extra pulmonary tuberculosis being 9.3% and pulmonary TB with candidiasis being 4.3 %. Many combined infections were noted.

Table 6 Shows CD4 count at diagnosis and recent with respect to Domains 1,2,3,4,5,6

Table 7 Shows Paired Samples Statistics of recent CD4 counts

Table 8 Shows paired sample tests and paired differences

Paired Samples Test

• Difference between CD4 count at starting and recent CD4 count 1 is very highly significant statistically with p-value <0.001
• Difference between CD4 count at diagnosis and recent CD4 count 2 is also very highly significant with p-value <0.001
• Difference between recent CD4 count 1 and recent CD4 count 2 is also very highly significant with p-value <0.001.

Table 9 shows distribution of HIV and no. of years on ART

NO OF YRS ON ART

Table 10 Shows frequency of HIV cases on Combined ART regimen

c ART REGIMEN

In our study age distribution 18 to 20 years are 2%, 21 to 30 are 15%, 31 to 40 50.3%, 41 to 50 are 24.3%, 51 to 60 are 6.7%, 61 to 70 are 1.3% and 71 to 80 are 1%. This indicates main age group affected is between 31 to 40 years (50.30%) indicating young age group is mainly affected. According to study on Estimate of HIV prevalence and number of people living with HIV in India 2008–2009 Arvind Pandey, Damodar Sahu, Taoufi Bakkali, DCS Reddy, S Venkatesh, Shashi Kant, M Bhattacharya, et al. estimated number of PLHIV in India is 2.4 million (1.93–3.04 million) in 2009. Of which, 39% are women, children under 15 years of age account for 4.4% of all infections, while people aged 15–49 years account for 82.4% of all infected with HIV. (16) In our study, 70% were male patients and 30% were female indicating more number of HIV cases in male population, that is more than 50 % are males compared to females Women account for more than 1/2 the wide variety of humans dwelling with HIV worldwide. Young girls (10-24 years old) are twice as probably to acquire HIV as younger men the identical age17.

HIV disproportionately influences ladies and adolescent ladies because of vulnerabilities created by means of unequal cultural, social and financial status. Unaccommodating attitudes in the direction of sex outside of marriage and the restrained social autonomy of girls and young girls can minimize their potential to get entry to sexual fitness and HIV services. Much has been carried out to limit mother to child transmission of HIV, but a whole lot more needs to be executed to limit the gender inequality and violence that ladies and women at risk of HIV regularly face.

93.3% of HIV patients were heterosexual, 2 % were homosexual, 4.7% was mother to child transmission. Similar findings were noted in study done in coastal India, KMC Mangalore18 in 2015 which found 98.9% of HIV cases with heterosexual transmission.

A multitude of chance factors, such as the lack of male circumcision, concurrent and multiple partnerships, and migratory patterns, operates to create a “perfect storm”; no single issue in itself can explain such HIV levels, due to the fact all of them individually exist elsewhere. The practice of multiple sexual partnerships has been proven to be the most important threat aspect in the transmission of HIV. 19

53.3% of HIV+ve cases did not have any opportunistic infections i.e.. Approximately 47% had opportunistic infections.16.7% of HIV+ve cases had pulmonary Tuberculosis, followed by extra pulmonary tuberculosis being 9.3% and pulmonary TB with candidiasis being 4.3 %. Many combined infections were noted.

Similar findings were noted in a study done by Debasu Damtie et al20 in which it was discovered that the general OI incidence was (n= 71/360, 19.7 present). Tuberculosis has appeared as the most common infection associated with HIV infection in patients across the overall range of CD4 + followed by oral candidiasis among the observed spectrum of OIs. Infection with tuberculosis was discovered to be common among patients (n= 35/360, 9.72%).

Also very high significant association was found between CD4 count at diagnosis and opportunistic infections (p-value <0.001) and no association with recent CD4 count with opportunistic infections. It implied that CD4 count on diagnosis was considerably low which increased with cART very significantly. According to studies, patients with HIV not on cART will survive for a maximum of 2 years only. But the fact that our patients were on ART for 10 years or long itself signifies that cART increased number the life expectancy.

In our study Major age group affected are between age 31-40 years. In our study we found increased incidence of HIV infection in males, in rural areas and in low education statuses peoples. Most common mode of transmission was sexual (heterosexual mode). CD4 count improved after initiating patient on cART. Incidence of Opportunistic infections has decreased in those who were on cART.

1. Johnson LF, Mossong J, Dorrington RE, Schomaker M, Hoffmann CJ, Keiser O, et al. Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS medicine. 2013 Apr 9;10(4):e1001418
2. MM Hamish, CO Catheri, B Jennifer, B Mark, R Darren, W Karrie et al. long term survival in PLHIV up to 15 years of ART.Nov2012/Volume 7/issue11/e48839.
3. Antonio MM, Alberto CS, Carlos HL, Gloria HG, Carlos DH. Clinical and epidemiological differences between women and men with HIV infection in Mexico. J AIDS Clin Res. 2016;7(551):2.
4. Trickey A, May MT, Vehreschild JJ, Obel N, Gill MJ, Crane HM, et al. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. The Lancet HIV. 2017 Aug 1;4(8):e349-56.
5. Brinkhof MW, Pujades-Rodriguez M, Egger M. Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis. PloS one. 2009 Jun 4;4(6):e5790.
6. Antiretroviral Therapy Cohort Collaboration. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. The Lancet. 2008 Jul 26;372(9635):293-9.
7. Poorolajal J, Hooshmand E, Mahjub H, Esmailnasab N, Jenabi E. Survival rate of AIDS disease and mortality in HIV-infected patients: a meta-analysis. Public health. 2016 Oct 1;139:3-12.
8. Unnikrishnan B, Holla R, Darshan BB, Arjun BY, Thapar R, Mithra P, et al. Clinico epidemiological profile of HIV-TB co-infected patients in Coastal South India. Manipal Journal of Nursing and Health Sciences (MJNHS). 2015;1(1):9-13.
9. Mutabazi-Mwesigire D, Katamba A, Martin F, Seeley J, Wu AW. Factors that affect quality of life among people living with HIV attending an urban clinic in Uganda: a cohort study. PloS one. 2015 Jun 3;10(6):e0126810.
10. Anand D, Puri S, Mathew M. Assessment of quality of life of HIV-positive people receiving ART: an Indian perspective. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine. 2012 Jul;37(3):165.
11. Dewan R, GK I, Jiloha RC. Assessment of quality of life among HIV positive people attending tertiary hospital of Delhi, India. J. Commun. Dis. 2009;41(2):101-8.
12. Santos EC, França Junior I, Lopes F. Quality of life of people living with HIV/AIDS in São Paulo, Brazil. Revista de saude publica. 2007 Dec;41:64-71.
13. Kumar A, Girish HO, SN Ayesha, Balu PS, Kumar BV., study done determinants of quality of life among people living with HIV/AIDS a cross sectional study in central Karnataka, INDIA. International journal of medical science and public health/2014/vol3/issue11.
14. Weiss RA, Dalgleish AG, Loveday C, Pillay D. Human Immunodeficiency Viruses. In: Zuckerman AJ, Banatvala JE, Pattison JR, Griffiths PD, Schoub BD(eds). Principles and Practice of Clinical Virology. 5th ed. 2004. Chichester:John Wiley & Sons Ltd, pp721-57.
15. Korber B, Muldoon M, Theiler J, Gao F, Gupta R, Lapedes A, et al. Timing the ancestor of the HIV-1 pandemic strains. science. 2000 Jun 9;288(5472):1789-96.
16. Lemey P, Pybus OG, Wang B, Saksena NK, Salemi M, Vandamme AM. Tracing the origin and history of the HIV-2 epidemic. Proceedings of the National Academy of Sciences. 2003 May 27;100(11):6588-92.
17. Cleghorn FR, Reitz MS, Popovic M, Gallo RC. Human immunodeficiency viruses. Bennett's principles and practice of infectious diseases. 6th ed. Philadelphia: Churchill Caurehill Livingston. 2005:2119-33.
18. Unnikrishnan B, Holla R, Darshan BB, Arjun BY, Thapar R, Mithra P, et al. Clinico epidemiological profile of HIV-TB co-infected patients in Coastal South India. Manipal Journal of Nursing and Health Sciences (MJNHS). 2015;1(1):9-13.
19. Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J. Estimating per-act HIV transmission risk: a systematic review. AIDS (London, England). 2014 Jun 19;28(10):1509.
20. Scully EP. Sex differences in HIV infection. Current HIV/AIDS Reports. 2018 Apr 1;15(2):136-46.