A prospective study to evaluate efficacy of second-line antiretroviral therapy given to human immunodeficiency virus patients at Antiretroviral Therapy Plus Centre in India.

INTRODUCTION: Despite a very large number of patients being covered under antiretroviral therapy (ART), there are limited data in the Indian population regarding second-line ART. Hence, this study was undertaken to evaluate the efficacy of second-line ART. MATERIALS AND METHODS: After consultation with the physician of ART Plus Centre, the patient was interviewed, and details of patients' case record were obtained. In our ART Plus Centre, CD4 count has been done at the start and after 6 months of second-line ART which were recorded as effectiveness indicator of second-line ART. RESULTS: Out of seventy patients, 16 (22.86%) had a history of second-line ART from private ART clinics and 54 (77.14%) patients were transferred from other government ART centers. The most common reason to start second-line ART was immunological failure in 27 patients. The mean increase in CD4 count of 106.09 cells/mm3 was observed after 6 months of second-line ART in 63 patients. The mean increase in CD4 count (57.16%) after 6 months was statistically significant (P < 0.05) with tenofovir + lamivudine + atazanavir/ritonavir regimen in forty patients. CONCLUSIONS: Irrational practice by private hospitals limits treatment options, with increasing the chances of drug resistance. On the other hand, the National AIDS Control Organization-sponsored second-line ART was found to be effective as 84.12% of patients had improvement in their mean CD4 count.

A comparative randomized open label study to evaluate efficacy, safety and cost effectiveness between topical 2% sertaconazole and topical 1% butenafine in tinea infections of skin.

BACKGROUND: Dermatophytoses are the superficial fungal infections of skin, hair, and nail. Butenafine is a benzylamine group of antifungal that inhibits the biosynthesis of ergosterol by blocking squalene epoxidase. Sertaconazole is a newer imidazole antifungal which inhibits the biosynthesis of ergosterol by inhibiting 14-α lanosterol demethylase. The study was done to compare a newer antifungal with a relatively older one. AIM: To compare the efficacy, safety and cost effectiveness of topical 2% sertaconazole cream and 1% butenafine in tinea infections of skin. MATERIALS AND METHODS: Patients were randomly allocated to two treatment groups. They were advised to apply the drug topically twice a day for one month on the lesions. They were followed up at an interval of 10 days. Clinical score and Global Evaluation Response were assessed at baseline and during each follow up. RESULTS: A total 125 patients were recruited, out of them 111 completed the whole study. Median Sign and Symptom Score of tinea on the baseline was 9 [5,9] that was reduced to 0 [0,4] by 2% sertaconazole while it was 9 [6,9] in the butenafine group on the baseline that was reduced to 0 [0,6] at the end of the treatment. 98% and 90% of the patients got complete clearance of the lesions with butenafine and sertaconazole, respectively. Treatment with butenafine was more cost effective as compared to sertaconazole. CONCLUSION: 1% butenafine is more efficacious, cost effective, and equally safe as compared to 2% sertaconazole in the tinea infections of skin.