Long-term experience and outcomes of programmatic antiretroviral therapy for HIV-2 infection in Senegal, West Africa

• Published in: Clinical infectious diseases
• Main Authors: Raugi, Dana N, Ba, Selly, Cisse, Ousseynou, Diallo, Khardiata, Tamba, Ibrahima Tito, Ndour, Cheikh, Badiane, Ndeye Mery Dia, Fortes, Louise, Diallo, Mouhamadou Baïla, Faye, Dominique, Smith, Robert A, Sall, Fatima, Toure, Macoumba, Sall, ElHadji Ibrahima, Diallo Agne, Habibatou, Faye, Khadim, Diatta, Jean Philippe, Sy, Marie Pierre, Chang, Ming, Diaw, Binetou, Sambou, Jacques, Bakhoum, Raphael, Sy, Mame Demba, Niang, Alassane, Malomar, Jean Jacques, Coombs, Robert W, Hawes, Stephen E, Ndoye, Ibra, Kiviat, Nancy B, Sow, Papa Salif, Seydi, Moussa, Gottlieb, Geoffrey S
• Format: Journal Article
• Language: English
• Published: United States 30.03.2020
• Subjects: HIV treatment; HIV-2; 90-90-90; antiretroviral therapy; viral suppression
• ISSN: 1537-6591

Programmatic treatment outcome data for people living with HIV-2 in West Africa, where the virus is most prevalent, are scarce. HIV-2-infected adults initiating or receiving 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 counts, antiretroviral drug resistance, loss to follow up, and mortality. We also examined changes in treatment guidelines over time and assessed progress toward UNAIDS' 90-90-90 targets for HIV-2. We enrolled 291 participants at two 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 two 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 multi-class 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 sub-optimal, and significant challenges to improving care remain.