Outcomes in a Cohort of Patients Started on Antiretroviral Treatment and Followed up for a Decade in an Urban Clinic in Uganda

• Published in: PloS one Vol. 10; no. 12; p. e0142722
• Main Authors: Castelnuovo, Barbara, Kiragga, Agnes, Musaazi, Joseph, Sempa, Joseph, Mubiru, Frank, Wanyama, Jane, Wandera, Bonnie, Kamya, Moses Robert, Kambugu, Andrew
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.12.2015; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; CD4 antigen; CD4 Lymphocyte Count - methods; Drug Administration Schedule; Efavirenz; Female; Follow-Up Studies; Health aspects; HIV; HIV Infections - drug therapy; HIV patients; HIV-1 - drug effects; Human immunodeficiency virus; Humans; Lamivudine; Lost to Follow-Up; Male; Mortality; Nevirapine; Patients; Prospective Studies; Reverse Transcriptase Inhibitors - therapeutic use; Stavudine; Systematic review; Toxicity; Uganda; Viral Load - methods; Zidovudine; Uganda; Sub-Saharan Africa; Kampala Uganda; Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0142722

Short-medium term studies from sub-Saharan Africa show that, despite high early mortality, substantial loss to program, and high rates toxicity, patients on antiretroviral treatment have achieved outcomes comparable to those in developed settings. However, these studies were unable to account for long term outcomes of patients as they stayed longer on treatment. We aim to describe ten years outcomes of one of the first cohort of HIV positive patients started on antiretroviral treatment (ART) in Sub-Saharan Africa. We report 10-years outcomes including mortality, retention, CD4-count response, virological outcomes, ART regimens change from a prospective cohort of 559 patients initiating ART and followed up for 10 years Uganda. Of 559 patients, 69.1% were female, median age (IQR) was 38 (33-44) years, median CD4-count (IQR) 98 (21-163) cell/μL; 74% were started on stavudine, lamivudine and nevirapine, 26% on zidovudine, lamivudine and efavirenz. After 10 years 361 (65%) patients were still in the study; 127 (22.7%) had died; 30 (5%) were lost to follow-up; 27 (5%) transferred; 18 (3%) withdrew consent. The probability of death was high in the first year (0.15, 95%, CI 0.12-0.18). The median CD4 count increased from 98 to 589 cell/μL (IQR: 450-739 cell/μL) with a median increase of 357 cells/μL (IQR: 128-600 cells/μL); 7.4% never attained initial viral suppression and of those who did 31.7% experienced viral failure. Three hundred and two patients had at least one drug substitution while on first line after a median of 40 months; 66 (11.9%) of the patients were switched to a second line PI-based regimen due to confirmed treatment failure. Despite the high rate of early mortality due to advanced disease at presentation the outcomes from this cohort are encouraging, particularly the remarkable and incremental immune-recovery and a satisfactory rate of virologic suppression.