Virologic and immunologic outcomes and programmatic challenges of an antiretroviral treatment pilot project in Abidjan, Côte d'Ivoire
| Autor: | Auguste Kadio, Eve M. Lackritz, Gaston Djomand, Thierry H. Roels, Fabien Diomande, Debra L. Hanson, Regina Konan-Koko, Chantal Maurice, Tedd V. Ellerbrock, Joseph Saba, John N. Nkengasong, Stefan Z. Wiktor, Terence Chorba, Bondo Monga |
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| Rok vydání: | 2003 |
| Předmět: |
Program evaluation
Adult Male medicine.medical_specialty Adolescent Cost effectiveness Anti-HIV Agents International Cooperation Immunology Developing country Cote d ivoire HIV Infections Pilot Projects Acquired immunodeficiency syndrome (AIDS) Antiretroviral Therapy Highly Active Antiretroviral treatment Immunology and Allergy Medicine Humans Child Developing Countries business.industry Viral Load medicine.disease Antiretroviral therapy CD4 Lymphocyte Count Government Programs Infectious Diseases Cote d'Ivoire Treatment Outcome Family medicine Physical therapy HIV-1 Reverse Transcriptase Inhibitors Female business Viral load Program Evaluation |
| Zdroj: | AIDS (London, England). 17 |
| ISSN: | 0269-9370 |
| Popis: | In Côbte d'Ivoire, a pilot project was developed by UNAIDS and the Ministry of Health to improve access to AIDS care, including antiretroviral therapy, for adults and children infected with HIV. This evaluation of the project is the first to provide results of a large number of HIV-infected patients receiving antiretroviral therapy in West Africa.We evaluated records of persons who presented for care from August 1998 to August 2000 at six accredited centers in Abidjan. Patients were treated with two nucleoside reverse transcriptase inhibitors (2NRTI) or highly active antiretroviral therapy (HAART).Of 2878 patients who were screened, 2351 (83%) were HIV-infected and eligible (CD4 T lymphocyte count500 x 10(6) cells/l or plasma HIV-RNA level10 000 copies/ml) for antiretroviral therapy. Of those who were eligible, 81% were symptomatic, 63% had a CD4 cell count200 x 10(6) cells/l, 12% had previously taken antiretroviral drugs, and 56% returned to the clinic for follow-up. Of the patients screened, 768 (27%) were started on antiretroviral therapy, including 450 on HAART, 296 on 2NRTI, and 22 on other regimens. We analyzed data from 480 HIV-1-infected adults, who were naive to therapy, were prescribed HAART or 2NRTI, and had at least one clinic visit after starting therapy. In an intent-to-treat analysis of patients who received HAART, the estimated plasma HIV-1 RNA level was approximately 1.9 log10 copies/ml (80-fold) lower, while estimated CD4 cell count was100 x 10(6) cells/l higher than baseline values, after 1 year of therapy. Approximately 25% of adults on 2NRTI and 50% of those on HAART had200 copies/ml, after 1 year of therapy. The probability of an adverse event occurring within 6 months after starting therapy was 0.20. The probability of survival for at least 1 year was 0.84 (95% confidence interval, 0.80-0.89).After starting antiretroviral therapy, these HIV-1-infected patients in West Africa had similar virologic and immunologic outcomes, probability of an adverse event, and estimated survival, as patients enrolled in clinical trials in the USA and Europe. However, only one-third of eligible patients received therapy, highlighting the importance of providing adequate education and support for initiating and adhering to therapy in this and similar programmes. |
| Databáze: | OpenAIRE |
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