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HIV disease progression in a patient cohort treated via a clinical research network in a resource limited setting

Duncombe, Chrisa; Kerr, Stephen Ja; Ruxrungtham, Kiata,b; Dore, Gregory Jc; Law, Matthew Gc; Emery, Seanc; Lange, Joep Md; Phanuphak, Praphana,b; Cooper, David Ac

Epidemiology and Social

Objective: To examine HIV disease progression in a cohort of adult patients treated with antiretroviral therapy (ART) via a clinical research network in Thailand.

Design, setting, participants and intervention: A cohort of 417 patients enrolled in a series of randomized ART trials, between 1996 and December 2002.

Main outcome measures: Progression to combined endpoint of AIDS defining illness or death according to baseline characteristics, ART used, immunological and virological responses to initial 6 months of ART.

Results: During 1677 person years of follow-up, 29 of 417 patients progressed; tuberculosis was the most common event defining progression (14 of 29 events). The rates of progression to combined endpoint or death alone were 1.7 [95% confidence interval (CI), 1.1–2.4] and 0.7 (95% CI, 0.3–1.3) per 10 person years respectively. Compared to patients with baseline CD4 cell counts ≥350 × 106/l, the adjusted hazard ratio (HR) for progression was 3.67 (95% CI, 1.31–10.27) for patients with <200 × 106 cells/l. Responses to 6 months of therapy were the strongest predictors of disease progression; compared to patients with undetectable viral load at 6 months, HR for progression was 4.95 (95% CI, 2.14–11.46) for viral load >4 log10. Compared to patients with a 6-month CD4 cell count ≥350 × 106/l, HR for progression was 5.22 (95% CI, 1.90–14.37) for patients with <200 × 106 cells/l.

Conclusions: HIV-infected patients in Thailand who had access to ART, appropriate care, CD4 cell and viral load monitoring facilities via a clinical research network had progression rates comparable to those in developed countries. In this setting, ART initiation could generally be delayed until the CD4 cell count approaches 200 × 106/l.

From the aHIV Netherlands Australia Thailand Research Collaboration

bDepartment of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

cNational Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia

dInternational Antiviral Therapy Evaluation Center, Departments of Internal, Medicine and Human Retrovirology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

Received 7 July, 2004

Revised 15 September, 2004

Accepted 27 September, 2004

Correspondence to C. Dumcombe, Senior Staff Physician, HIV-NAT, 104 Ratchadamri Road, Bangkok 10330, Thailand. E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.