ABSTRACT
Background: India has rapidly scaled up its programme for antiretroviral therapy(ART). There is high potential for the emergence of HIV drug resistance (HIVDR),with an increasing number of patients on ART. It is not feasible to perform testingfor HIVDR using laboratory genotyping, owing to economic constraints. This studypiloted World Health Organization (WHO) early-warning indicators (EWIs) forHIVDR, and quality-of-care indicators (QCIs), in four ART clinics in Pune city.Methods: A retrospective study was conducted in 2015, among four ART clinicsin Pune city, India. The data on four standardized EWIs (EWI 1: On-time pill pickup, EWI 2: Retention of patients in ART care at 12 months after initiation, EWI 3:Pharmacy stock-out, EWI 4: Pharmacy dispensing practices) and three QCIs(QCI 1: Regularity in CD4 testing in patients taking ART, QCI 2: Percentage ofpatients initiating ART within 30 days of medical eligibility, QCI 3: Percentage ofpatients initiating ART within 30 days of initiation of anti-tuberculosis therapy) wereabstracted into WHO Excel HIV data abstractor tools, from the patient recordsfrom April 2013 to March 2014.Results: All four ART clinics met the EWI 4 target (100%) for ART dispensingpractices. The target for EWIs on-time pill-pick (EWI 1 >90%) and pharmacy stockouts (EWI 3: no stock-outs, 100%) were achieved in one clinic. None of the clinicsmet the EWI 2 target for retention in care at 12 months (>90%) and the overallretention was 76% (95% confidence interval: 73% to 79%). The targets for QCI 1and QCI 2 (>90% each) were achieved in one and two clinics respectively. Noneof the clinics achieved the target for QCI 3 (>90%).Conclusion: ART dispensing practices (EWI 4) were excellent in all clinics. Effortsare required to strengthen retention in care and timely pill pick-up and ensurecontinuity of clinic-level drug supply among the programme clinics in Pune city.The clinics should focus on regularity in testing CD4 count and timely initiation ofART
Subject(s)
IndiaABSTRACT
The dendritic cell subsets myeloid dendritic cells (mDCs) and plasmacytoid dendritic cells (pDCs) play an important role in HIV pathogenesis. While pDCs play a major role in the innate immune response, mDCs are important for induction of the antigen-specific immune response. We studied pDCs and mDCs at different stages of HIV infection, and found that there were decreased percentages of pDCs and mDCs in the advanced stage of the disease (p < 0.0001), and that slow progressors did not show as great a decrease as more healthy individuals. Persons who had acquired infection within the last year showed a normal mDC percentage but a lower pDC percentage (p = 0.0092) than healthy individuals (0.16%). pDC percentages in those with late-stage disease did not revert to normal after successful antiretroviral therapy (ART), whereas mDC percentages reverted to levels comparable to those seen in the healthy population (0.08% pre-ART to 0.18% post-ART; p < 0.0001). The pDC population had high levels of apoptotic markers in those with recent (p = 0.0025) and advanced (p = 0.0012) HIV infection, with no difference in their migratory capacity from controls and slow progressors, indicating that apoptosis is the major mechanism of declining pDC numbers in the circulation. mDCs showed increased levels of apoptotic markers (p = 0.0012), as well as migration (p = 0.03), in those with advanced-stage disease compared to controls, suggesting that both migration and apoptosis contribute to the decline seen in mDCs in the circulation. The irreversible loss of pDCs due to apoptosis seen early in HIV infection may be responsible for an impaired innate anti-HIV immune response. However, the presence of functionally-competent pDCs in slow progressors implies that the loss of pDCs early in infection may be critical to control of HIV infection through innate immune mechanisms, and may influence the progression of disease.
