Long-term Experience and Outcomes of Programmatic Antiretroviral Therapy for Human Immunodeficiency Virus Type 2 Infection in Senegal, West Africa
- 30 March 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 72 (3), 369-378
- https://doi.org/10.1093/cid/ciaa277
Abstract
Programmatic treatment outcome data for people living with human immunodeficiency virus type 2 (HIV-2) in West Africa, where the virus is most prevalent, are scarce. Adults with HIV-2 initiating or receiving antiretroviral therapy (ART) through the Senegalese national AIDS program were invited to participate in this prospective, longitudinal observational cohort study. We analyzed HIV-2 viral loads, CD4 cell counts, antiretroviral drug resistance, loss to follow-up, and mortality. We also examined changes in treatment guidelines over time and assessed progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets for HIV-2. We enrolled 291 participants at 2 sites for 926.0 person-years of follow-up over 13 years. Median follow-up time was 2.2 years per participant. There were 21 deaths reported (7.2%), and 117 individuals (40.2%) were lost to follow-up, including 43 (14.7%) who had an initial visit but never returned for follow-up. CD4 counts and HIV-2 viral suppression (< 50 copies/mL) at enrollment increased over calendar time. Over the study period, 76.7% of plasma viral loads for participants receiving ART were suppressed, and median CD4 gain was 84 cells/μL in participants’ first 2 years on study. Since the UNAIDS 90-90-90 strategy was published, 88.1% of viral loads were suppressed. Fifteen percent of patients experienced virologic failure with no known resistance mutations, while 56% had evidence of multiclass drug resistance. Participants in the Senegalese national AIDS program are initiating ART earlier in the course of disease, and more modern therapeutic regimens have improved outcomes among those receiving therapy. Despite these achievements, HIV-2 treatment remains suboptimal, and significant challenges to improving care remain.Funding Information
- National Institute of Allergy and Infectious Diseases
- National Institutes of Health (2R01-AI060466, R01-AI120765)
- AIDS Clinical Trials Group (UM1-AI-068636, UM1-AI-106701)
- UW Center for AIDS Research Retrovirology Core (P30-AI-027757)
This publication has 34 references indexed in Scilit:
- Immunovirological Response to Triple Nucleotide Reverse-Transcriptase Inhibitors and Ritonavir-Boosted Protease Inhibitors in Treatment-Naive HIV-2-Infected Patients: The ACHIEV2E Collaboration Study GroupClinical Infectious Diseases, 2011
- Long-term nonprogressors and elite controllers in the ANRS CO5 HIV-2 cohortAIDS, 2011
- British HIV Association guidelines for antiretroviral treatment of HIV‐2‐positive individuals 2010HIV Medicine, 2010
- Virological Response to Highly Active Antiretroviral Therapy in Patients Infected with Human Immunodeficiency Virus Type 2 (HIV-2) and in Patients Dually Infected with HIV-1 and HIV-2 in The Gambia and Emergence of Drug-Resistant VariantsJournal of Clinical Microbiology, 2009
- Antiretroviral drug resistance in HIV-2: three amino acid changes are sufficient for classwide nucleoside analogue resistance.The Journal of Infectious Diseases, 2009
- Emergence of Multiclass Drug–Resistance in HIV‐2 in Antiretroviral‐Treated Individuals in Senegal: Implications for HIV‐2 Treatment in Resouce‐Limited West AfricaClinical Infectious Diseases, 2009
- Equal Plasma Viral Loads Predict a Similar Rate of CD4+T Cell Decline in Human Immunodeficiency Virus (HIV) Type 1– and HIV‐2–Infected Individuals from Senegal, West AfricaThe Journal of Infectious Diseases, 2002
- Reduced Rate of Disease Development After HIV-2 Infection as Compared to HIV-1Science, 1994
- Slower heterosexual spread of HIV-2 than HIV-1The Lancet, 1994
- Cellular and plasma viral load in patients infected with HIV-2AIDS, 1993