Effectiveness of Combined Anti Retroviral Therapy [cART] on Viral Load and Cd 4 Count, in Reducing Progression to AIDS, in Improving the Quality of Life of Patients of HIV/AIDS in the Context of the U.N. Sustainable Development Goals (SDGs).

A 5-Year Prospective Study in Himachal Pradesh (India)

Abstract

Background: The increasing prevalence of the Human Immunodeficiency Virus (HIV)  every forthcoming year continues to pose a serious threat to mankind. This global problem and its sequelae cause significant loss of precious lives every year despite advances in Antiretroviral (ARV) therapy. CD4 cell count is an essential component in monitoring HIV treatment outcomes but its monitoring sometimes is unable to estimate the virological failure leading to a switch of treatment lines that leads to drug resistance and limiting of options for patients. CD4 count still is the best measurement of an HIV patient’s immune and clinical status, the threat of opportunistic infections, and diagnostic decision-making, especially for patients with advanced HIV disease. Aims and Objectives: This study is an attempt to assess the effectiveness of cART on Cd 4 count and Viral load both as predictors of HIV/AIDS by monitoring the progression of the disease by determining the CD4 level and HIV RNA Viral load and reducing the progression of AIDS improving the quality of life of patients of HIV/AIDS in the context of the U.N. sustainable development goals. Material and Methods:  492 HIV patients were analyzed over five years. Models were selected, for various parameters like CD4 cell count monitoring and HIV load RNA monitoring. Effects of various covariates; gender, age, CD4 baseline count, HIV RNA baseline count, and patient's adherence to treatment were assessed for each of the fitted models. To assess the extent International or U.N. policies are being implemented concerning Viral load and CD4 testing in practice. We also draw on data from key informant interviews to contextualize the policy content and national implementation strategies, and from qualitative interviews with service providers and users to explore how tests are being conducted and interpreted in everyday clinical practice. Results: For people living with HIV/AIDS Antiretroviral therapy must be consumed throughout life to inhibit the levels of the HIV/AIDS virus as it is a  chronic disabling disease and improving the quality of life depends on cART adherence and psychosocial support. Results from this analysis revealed that viral load monitoring is a better predictor of HIV/AIDS progression and deaths in HIV/AIDS patients in comparison to CD4 cell count monitoring. Conclusions: Our study concludes that both CD4 and HIV viral load should be performed on patients alternately to cover both aspects of patient management.