CLINICAL-IMMUNOLOGICAL ASSESSMENT FAILURE ON INITIAL COMBINATION USE OF ZIDOVUDINE-LAMIVUDINE-NEVIRAPINE IN CHILDREN WITH HIV/AIDS AT SANGLAH HOSPITAL BALI

• Main Authors: R. Niruri, A. A. S. Maharani, K. D. Kumara, and I. M. Rahajeng
• Format: Article
• Language: English
• Published: DiscoverSys 2014-05-01
• Series: Bali Medical Journal
• Subjects: first-line arv, failure, children
• Online Access: https://balimedicaljournal.org/index.php/bmj/article/view/77
• ISSN: 2089-1180; 2302-2914

<p><strong>Background: </strong>Assessing clinical progression and CD4⁺ level were important in determining the efficacy of antiretroviral (ARV) and switching to other regimens, especially when viral-load data were not available.   This research aims to assess combination of zidovudine-lamivudine-nevirapine (Co-ZLN) failure using  WHO 2010 criteria on clinical failure (CF) and immunological failure (IF), single or together, to determine correlation between CF and IF; and to evaluate two failure categories (CF alone and combination of CF-IF) in making decision to switch to second-line of ARV. <strong>Methods:</strong> Children at Sanglah General Hospital, who gain initial treatment of Co-ZLN in period of March 2006–March 2013 were selected. Cross-sectional study was applied. The ARV response was assessed twice. First period (P1) and second period (P2) of evaluation were conducted after patients received the Co-ZLN at least 6 and 12 months. <strong>Results:</strong> Forty five patients were included in this study. After at least 6 and 12 months of therapy, more patients showed IF (10 and 9 children in P1 and P2) than those in CF (4 and 2 patients in P1 and P2). Only one child met to CF-IF category in P2. The low clinical condition (HIV stage 4) did not always associate with deteriorating immunologic marker in the treatment-failure (TF). The patients who fit on CF and CF-IF based decision to switch regimen criteria were different. In resource-limited hospital, CF-IF based decision could give a better picture of patients’ condition and be used as an indicator to assess TF compared to single CF criteria.</p>