ABSTRACT
The National Programme in India provides free third-line antiretroviral treatment (ART) for all people living with HIV (PLHIV). Data of 232 PLHIV initiated on third-line ART from a single center in New Delhi were retrospectively analyzed for virological suppression at 6 and 12 months, factors predicting nonresponse, retention in care, and mortality from June 2016 till December 2019. The mean age at third-line ART initiation was 39.54 ± 11.08 years, 71.5% were males, and 55.02% had HIV duration of >10 years. The mean CD4 count at third-line ART initiation was 260.04 ± 200.4/mm3, and the median viral load (VL) at second-line failure was 61,253 copies/mL (interquartile range, 12,599-315,497 copies/mL). Of the patients, 71.52% achieved virological suppression at 6 months (n = 151), and this was maintained at 12 months-72% (n = 50). The mortality rate among those still in active care was 8.69% (18/207). PLHIV who did not attain virological suppression at 6 months had significantly shorter duration on second-line ART (p = 0.0002), lower peak CD4 achieved on second-line ART (p = 0.039), higher VL at second-line failure (p = 0.012), and lower body weight (p < 0.0001). On univariate analysis, lower CD4 peak on second-line ART (p = 0.019), lower CD4 count at third-line ART initiation (p = 0.004), and lower body weight (p = 0.0002) were significantly predictive of virological nonsuppression at 6 months. Successful implementation of a third-line ART program can indeed be done through a public health approach. Intensive adherence support, nutritional rehabilitation, and regular viral load monitoring are crucial for improved clinical and virological outcomes.
Subject(s)
Anti-HIV Agents , HIV Infections , Anti-HIV Agents/therapeutic use , CD4 Lymphocyte Count , Cohort Studies , Female , HIV Infections/drug therapy , Health Facilities , Humans , India/epidemiology , Male , Retrospective Studies , Treatment Failure , Treatment Outcome , Viral LoadABSTRACT
Cartilage hair hypoplasia is a genetic disease, characterized by generalized metaphyseal dysplasia mainly affecting the knee joints. Variable extraskeletal features like anemia, malabsorption, impaired spermatogenesis, impaired immunity, and malignancies have been reported. The work up of malabsorption and short stature led to the diagnosis of celiac disease in three previous cases of cartilage hair hypoplasia. Here, we report an Indian girl with a novel genotype, diagnosed as celiac disease with cartilage hair hypoplasia, and review the previous three cases.
Subject(s)
Celiac Disease/genetics , Hair/abnormalities , Hirschsprung Disease/genetics , Immunologic Deficiency Syndromes/genetics , Osteochondrodysplasias/congenital , Adolescent , Biopsy , Celiac Disease/pathology , DNA Mutational Analysis , Female , Genotype , Hair/pathology , Hirschsprung Disease/pathology , Humans , Immunologic Deficiency Syndromes/pathology , India , Osteochondrodysplasias/genetics , Osteochondrodysplasias/pathology , Primary Immunodeficiency DiseasesABSTRACT
Clinical profile of children presenting with poisoning to the Pediatric emergency department of a tertiary care hospital in Delhi from 8.1.2009 to 8.10.09 was studied prospectively. Fifty two cases of accidental poisoning were reported during this period which formed 1.05 % of all pediatric admissions (5094 admissions). No case of homicidal poisoning was reported. There were 80.7 % children between 1-5 y of age with male preponderance. PICA was observed in 57.7 % children. Overall mortality was 7.7 % and 11.3 % children required pediatric intensive care unit (PICU). Kerosene oil poisoning remained the commonest accidental poisoning in this study. An interesting trend was concentrated HCL poisoning (now a common household product) as the second commonest poisoning (17.3 %). This was followed by poisoning with various drugs used by adults in the house.
