A decade of HAART in Latin America: Long term outcomes among the first wave of HIV patients to receive combination therapy
Author
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Wolff Reyes, Marcelo
Author
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Giganti, Mark J.
Author
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Cortés Moncada, Claudia
Author
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Cahn, Pedro
Author
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Grinsztejn, Beatriz
Author
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Pape, Jean W.
Author
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Padgett, Denis
Author
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Sierra Madero, Juan
Author
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Gotuzzo, Eduardo
Author
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Duda, Stephany N.
Author
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McGowan, Catherine C.
Author
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Shepherd, Bryan E.
Admission date
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2018-05-14T17:24:51Z
Available date
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2018-05-14T17:24:51Z
Publication date
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2017
Cita de ítem
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Plos One 12(6): e0179769
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Identifier
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10.1371/journal.pone.0179769
Identifier
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https://repositorio.uchile.cl/handle/2250/147721
Abstract
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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-naive. 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/mm(3). 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-naive, 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.
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Patrocinador
dc.description.sponsorship
National Institute of Allergy and Infectious Diseases (NIAID) /
National Cancer Institute (NCI) /
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) as part of the International epidemiologic Databases to Evaluate AIDS (IeDEA), U01 Al069923