Prognostic value of virological and immunological responses after 6 months of antiretroviral treatment in adults with HIV-1 infection in Sub-Saharan Africa. Andrea.
J Acquir Immune Defic Syndr. 2011 Nov 30;
Authors: Luca D, Marazzi MC, Mancinelli S, Ceffa S, Doro Altan AM, Buonomo E, Felice Prosperi MC, Pedruzzi B, Noorjehan AM, Scarcella P, Liotta G, Palombi L
Abstract
BACKGROUND: HIV-RNA monitoring is not available in most antiretroviral treatment (ART) programs in sub-Saharan Africa; switch to second-line therapy is mostly guided by clinical/immunological criteria. This may lead to unnecessary disease progression and drug-resistance accumulation. We investigated the prognostic value of virological and immunological status 6-months after ART initiation with respect to death, loss to follow-up and treatment switch. METHODS: We considered treatment-naive HIV-1 infected patients, starting ART with available 6-month visit and subsequent follow-up, enrolled in a prospective cohort comprising five ART sites in 3 sub-Saharan countries. Outcome measures included the time from 6-month visit to death for all causes, loss to follow-up and switch to second-line. RESULTS: Of 2,539 patients, 62% were females, their median pre-ART CD4 count was 215 cells/microliter, median HIV-RNA 4.6 Log10 copies/mL, 30% were on WHO stage III/IV. At 6-months, 85% had HIV-RNA<1,000 copies/mL. During 3,112 person-years follow-up (PYFU) after the 6-month visit, 91 patients died. Death was predicted by 6-month HIV-RNA≥10,000 copies/mL, adherence and 6-month CD4<200 cells/microliter. The 2-year estimated probability of surviving ranged from 0.69 (with 6-month HIV-RNA≥10,000 and CD4<200) to 0.95 (with HIV-RNA<1,000 and CD4≥200). Loss to follow-up (1.95/100 PYFU) was predicted by the 6-month HIV-RNA>10,000 copies/mL and adherence, but not by CD4. Switch to second-line (6.94/100 PYFU) was predicted by 6-month HIV-RNA and CD4. CONCLUSIONS: In patients starting ART in sub-Saharan Africa, 6-month HIV-RNA independently predicts subsequent survival, retention to care and switch to second-line therapy. This measure warrants further evaluation as specific time point monitoring option.
PMID: 22134148 [PubMed - as supplied by publisher]
References
- Luca D, Marazzi MC, Mancinelli S, Ceffa S, Doro Altan AM, Buonomo E, Felice Prosperi MC, Pedruzzi B, Noorjehan AM, Scarcella P, Liotta G, Palombi L. Prognostic value of virological and immunological responses after 6 months of antiretroviral treatment in adults with HIV-1 infection in Sub-Saharan Africa. Andrea. J Acquir Immune Defic Syndr. 2011 Nov 30. PMID: 22134148.
Similar Products: Powered by 
 |
Efficient HIV/AIDS care in resource-limited settings: Strategies to optimize HIV care and treatment outcomes in resource-limited settings :: Amazon Sub-Saharan Africa (SSA) is home for 67% of HIV- infected individuals, 68% of new HIV infections and 72% of AIDS-related deaths. Up to 80% o |
 |
The Socioeconomic Dimensions of HIV/AIDS in Africa :: Amazon Since the 1980s HIV/AIDS has occupied a singular position because of the rapidly emergent threat and devastation the disease has caused, par |
Related posts:
- [Articles] Effect of pretreatment HIV-1 drug resistance on immunological, virological, and drug-resistance outcomes of first-line antiretroviral treatment in sub-Saharan Africa: a multicentre cohort study
- Reduced mortality and loss to follow-up in integrated compared with vertical programmes providing antiretroviral treatment in sub-Saharan Africa.
- The importance of clinic attendance in the first six months on antiretroviral treatment: a retrospective analysis at a large public sector HIV clinic in South Africa
- [Articles] HIV-1 drug resistance in antiretroviral-naive individuals in sub-Saharan Africa after rollout of antiretroviral therapy: a multicentre observational study
- Long-term adherence to antiretroviral treatment and program drop-out in a high-risk urban setting in sub-saharan Africa: a prospective cohort study.
