A decade of HAART in Latin America: Long term outcomes among the first wave of HIV patients to receive combination therapy.

Autor: Wolff MJ; Fundación Arriarán, Facultad de Medicina, Universidad de Chile, Santiago, Chile., Giganti MJ; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America., Cortes CP; Fundación Arriarán, Facultad de Medicina, Universidad de Chile, Santiago, Chile., Cahn P; Fundación Huésped, Buenos Aires, Argentina., Grinsztejn B; Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil., Pape JW; Le Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti., Padgett D; Instituto Hondureño de Seguridad Social Hospital de Especialidades, Tegucigalpa, Honduras., Sierra-Madero J; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Talplan, Mexico., Gotuzzo E; Universidad Peruana Cayetano Heredia, Hospital Nacional Cayetano Heredia, Lima, Perú., Duda SN; Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States of America., McGowan CC; Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America., Shepherd BE; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2017 Jun 26; Vol. 12 (6), pp. e0179769. Date of Electronic Publication: 2017 Jun 26 (Print Publication: 2017).
DOI: 10.1371/journal.pone.0179769
Abstrakt: Background: In Latin America, the first wave of HIV-infected patients initiated highly active antiretroviral therapy (HAART) 10 or more years ago. Characterizing their treatment experience and corresponding outcomes across a decade of HAART may yield insights relevant to the ongoing care of such patients and those initiating HAART more recently in similar clinical settings.
Methods: This retrospective study included adults initiating HAART before 2004 at 8 sites in Argentina, Brazil, Chile, Haiti, Honduras, and Mexico. Patient status (in care, dead, or lost to follow-up [LTFU]) was assessed at 6-month intervals for 10 years, along with CD4 count and HIV-1 viral load (VL) for patients in care.
Results: 4,975 patients (66% male) started HAART prior to 2004; 45% were not antiretroviral-naïve. At 1, 5, and 10 years, rates of mortality were 4.2%, 9.0%, and 13.6% respectively. LTFU rates for the same periods were 2.4%, 10.9%, and 24.2%. Among patients remaining in care at 10 years, 84.4% were estimated to have VL≤400 copies/mL (Haiti excluded) and median baseline CD4 increased from 158 to 525 cells/mm3. Only 11.4% of all patients remained on their first regimen, 12.6% were on their second, 11.5% were on their third, and 23.0% were on their fourth or subsequent regimen. Outcomes were generally better for patients who were not antiretroviral-naïve, except for viral suppression. Heterogeneity among sites was substantial.
Conclusions: Despite advanced disease and predominant use of older antiretrovirals, a large percentage of early HAART initiators in this Latin American cohort were alive and in care with sustained virologic suppression and progressive immune recovery after 10 years.
Databáze: MEDLINE
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