Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality
Objective. To define the long-term (2–4 years) clinical and virological outcome of an antiretroviral treatment (ART) programme in rural South Africa. Methods. We performed a retrospective observational cohort study, including 735 patients who initiated ART. Biannual monitoring, including HIV-RNA te...
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| Format: | Article |
| Language: | English |
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Wiley
2011-01-01
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| Series: | AIDS Research and Treatment |
| Online Access: | http://dx.doi.org/10.1155/2011/434375 |
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| _version_ | 1832547563741380608 |
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| author | Roos E. Barth Hugo A. Tempelman Robert Moraba Andy I. M. Hoepelman |
| author_facet | Roos E. Barth Hugo A. Tempelman Robert Moraba Andy I. M. Hoepelman |
| author_sort | Roos E. Barth |
| collection | DOAJ |
| description | Objective. To define the long-term (2–4 years) clinical and virological outcome of an antiretroviral treatment (ART) programme in rural South Africa.
Methods. We performed a retrospective observational cohort study, including 735 patients who initiated ART. Biannual monitoring, including HIV-RNA testing, was performed. Primary endpoint was patient retention; virological suppression (HIV-RNA < 50 copies/mL) and failure (HIV-RNA > 1000 copies/mL) were secondary endpoints. Moreover, possible predictors of treatment failure were analyzed.
Results. 63% of patients (466/735) have a fully suppressed HIV-RNA, a median of three years after treatment initiation. Early mortality was high: 14% died within 3 months after treatment start. 16% of patients experienced virological failure, but only 4% was switched to second-line ART. Male gender and a low performance score were associated with treatment failure; immunological failure was a poor predictor of virological failure.
Conclusions. An “all or nothing” phenomenon was observed in this rural South African ART programme: high early attrition, but good virological control in those remaining in care. Continued efforts are needed to enrol patients earlier. Furthermore, the observed viro-immunological dissociation emphasises the need to make HIV-RNA testing more widely available. |
| format | Article |
| id | doaj-art-39403560d6614f4db718301d40dd9c09 |
| institution | Kabale University |
| issn | 2090-1240 2090-1259 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | AIDS Research and Treatment |
| spelling | doaj-art-39403560d6614f4db718301d40dd9c092025-02-03T06:44:23ZengWileyAIDS Research and Treatment2090-12402090-12592011-01-01201110.1155/2011/434375434375Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early MortalityRoos E. Barth0Hugo A. Tempelman1Robert Moraba2Andy I. M. Hoepelman3Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, F02.126, Postbus 85500, 3508 GA Utrecht, The NetherlandsNdlovu Medical Centre, Elandsdoorn, P.O. Box 1508, Groblersdal 0470, South AfricaNdlovu Medical Centre, Elandsdoorn, P.O. Box 1508, Groblersdal 0470, South AfricaDepartment of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, F02.126, Postbus 85500, 3508 GA Utrecht, The NetherlandsObjective. To define the long-term (2–4 years) clinical and virological outcome of an antiretroviral treatment (ART) programme in rural South Africa. Methods. We performed a retrospective observational cohort study, including 735 patients who initiated ART. Biannual monitoring, including HIV-RNA testing, was performed. Primary endpoint was patient retention; virological suppression (HIV-RNA < 50 copies/mL) and failure (HIV-RNA > 1000 copies/mL) were secondary endpoints. Moreover, possible predictors of treatment failure were analyzed. Results. 63% of patients (466/735) have a fully suppressed HIV-RNA, a median of three years after treatment initiation. Early mortality was high: 14% died within 3 months after treatment start. 16% of patients experienced virological failure, but only 4% was switched to second-line ART. Male gender and a low performance score were associated with treatment failure; immunological failure was a poor predictor of virological failure. Conclusions. An “all or nothing” phenomenon was observed in this rural South African ART programme: high early attrition, but good virological control in those remaining in care. Continued efforts are needed to enrol patients earlier. Furthermore, the observed viro-immunological dissociation emphasises the need to make HIV-RNA testing more widely available.http://dx.doi.org/10.1155/2011/434375 |
| spellingShingle | Roos E. Barth Hugo A. Tempelman Robert Moraba Andy I. M. Hoepelman Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality AIDS Research and Treatment |
| title | Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality |
| title_full | Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality |
| title_fullStr | Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality |
| title_full_unstemmed | Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality |
| title_short | Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality |
| title_sort | long term outcome of an hiv treatment programme in rural africa viral suppression despite early mortality |
| url | http://dx.doi.org/10.1155/2011/434375 |
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