Positive outcomes of HAART at 24 months in HIV-infected patients in Cambodia

• Published in: AIDS (London) Vol. 21; no. 17; pp. 2293 - 2301
• Main Authors: FERRADINI, Laurent, LAUREILLARD, Didier, BALKAN, Suna, QUILLET, Catherine, DELFRAISSY, Jean-Francois, PRAK, Narom, NGETH, Chanchhaya, FERNANDEZ, Marcelo, PINOGES, Loretxu, PUERTAS, Gloria, TABURET, Anne-Marie, LY, Nary, ROUZIOUX, Christine
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 12.11.2007
• Subjects: Adult; AIDS/HIV; Anti-HIV Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral Therapy, Highly Active; Antiviral agents; Benzoxazines - therapeutic use; Biological and medical sciences; Cambodia; CD4 Lymphocyte Count; Cross-Sectional Studies; Developing Countries; Feasibility Studies; Female; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - mortality; HIV-1 - genetics; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Lamivudine - therapeutic use; Logistic Models; Male; Medical sciences; Pharmacology. Drug treatments; Prospective Studies; RNA, Viral - blood; Stavudine - therapeutic use; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; Cambodia; Asia; Antiretroviral agent; Prognosis; Cambodia; antiretroviral therapy; Stavudine; Efavirenz; Body mass index; Microbiological investigation; Immunological investigation; outcomes; T-Lymphocyte; Adult; Antiviral; Viral load; Human; Immunopathology; observational cohort; Retroviridae; Lamivudine; AIDS; Immune deficiency; Lentivirus; Survival; Infection; Virus; Polymerase chain reaction; Chemotherapy; Treatment; HIV; Viral disease; Human immunodeficiency virus; Molecular biology
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0b013e32828cc8b7

African and Asian cohort studies have demonstrated the feasibility and efficacy of HAART in resource-poor settings. The long-term virological outcome and clinico-immunological criteria of success remain important questions. We report the outcomes at 24 months of antiretroviral therapy (ART) in patients treated in a Médecins Sans Frontières/Ministry of Health programme in Cambodia. Adults who started HAART 24 +/- 2 months ago were included. Plasma HIV-RNA levels were assessed by real-time polymerase chain reaction. Factors associated with virological failure were analysed using logistic regression. Of 416 patients, 59.2% were men; the median age was 33.6 years. At baseline, 95.2% were ART naive, 48.9% were at WHO stage IV, and 41.6% had a body mass index less than 18 kg/m. The median CD4 cell count was 11 cells/microl. A stavudine-lamivudine-efavirenz-containing regimen was initiated predominantly (81.0%). At follow-up (median 23.8 months), 350 (84.1%) were still on HAART, 53 (12.7%) had died, six (1.4%) were transferred, and seven (1.7%) were lost to follow-up. Estimates of survival were 85.5% at 24 months. Of 346 tested patients, 259 (74.1%) had CD4 cell counts greater than 200 cells/microl and 306 (88.4%) had viral loads of less than 400 copies/ml. Factors associated with virological failure at 24 months were non-antiretroviral naive, an insufficient CD4 cell gain of less than 350 cells/microl or a low trough plasma ART concentration. In an intention-to-treat analysis, 73.6% of patients were successfully treated. Positive results after 2 years of advanced HIV further demonstrate the efficacy of HAART in the medium term in resource-limited settings.