Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality
Open Access
- 21 November 2010
- journal article
- research article
- Published by Hindawi Limited in AIDS Research and Treatment
- Vol. 2011, 1-5
- https://doi.org/10.1155/2011/434375
Abstract
Objective. To define the long-term (24 years) clinical and virological outcome of an antiretroviral treatment (ART) programme in rural South Africa. Methods. We performed a retrospective observational cohort study, including 735 patients who initiated ART. Biannual monitoring, including HIV-RNA testing, was performed. Primary endpoint was patient retention; virological suppression (HIV-RNA 1000 copies/mL) were secondary endpoints. Moreover, possible predictors of treatment failure were analyzed. Results. 63% of patients (466/735) have a fully suppressed HIV-RNA, a median of three years after treatment initiation. Early mortality was high: 14% died within 3 months after treatment start. 16% of patients experienced virological failure, but only 4% was switched to second-line ART. Male gender and a low performance score were associated with treatment failure; immunological failure was a poor predictor of virological failure. Conclusions. An all or nothing phenomenon was observed in this rural South African ART programme: high early attrition, but good virological control in those remaining in care. Continued efforts are needed to enrol patients earlier. Furthermore, the observed viro-immunological dissociation emphasises the need to make HIV-RNA testing more widely available.Keywords
This publication has 19 references indexed in Scilit:
- Rate of Accumulation of Thymidine Analogue Mutations in Patients Continuing to Receive Virologically Failing Regimens Containing Zidovudine or Stavudine: Implications for Antiretroviral Therapy Programs in Resource‐Limited SettingsThe Journal of Infectious Diseases, 2009
- Misclassification of First‐Line Antiretroviral Treatment Failure Based on Immunological Monitoring of HIV Infection in Resource‐Limited SettingsClinical Infectious Diseases, 2009
- Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South AfricaEuropean Journal of Clinical Microbiology & Infectious Diseases, 2008
- Resistance profiles after different periods of exposure to a first-line antiretroviral regimen in a Cameroonian cohort of HIV type-1-infected patientsAntiviral Therapy, 2008
- Increased mortality of male adults with AIDS related to poor compliance to antiretroviral therapy in MalawiTropical Medicine & International Health, 2008
- Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic ReviewPLoS Medicine, 2007
- Sex issues in HIV-1-infected persons during highly active antiretroviral therapy: a systematic reviewJournal of Antimicrobial Chemotherapy, 2007
- Sex differences in the clinical, immunological and virological parameters of HIV-infected patients treated with HAARTAIDS, 2007
- Virological response to a triple nucleoside/nucleotide analogue regimen over 48 weeks in HIV-1-infected adults in AfricaAIDS, 2006
- Medium-Term Survival, Morbidity and Immunovirological Evolution in HIV-Infected Adults Receiving Antiretroviral Therapy, Abidjan, Côte D'IvoireAntiviral Therapy, 2002