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Five-year outcomes of initial patients treated in Botswana's National Antiretroviral Treatment Program

Bussmann, Hermann; Wester, C William; Ndwapi, Ndwapi; Grundmann, Nicolas; Gaolathe, Tendani; Puvimanasinghe, John; Avalos, Ava; Mine, Madisa; Seipone, Khumo; Essex, Max; deGruttola, Victor; Marlink, Richard G

doi: 10.1097/QAD.0b013e3283129db0
Clinical Science

Background: Antiretroviral treatment (ART) initiatives have now been established in many sub-Saharan African countries showing early benefits. To date, few results are available concerning long-term clinical outcomes in these treatment programs.

Methods: Response to ART is described in the first HIV-1C-infected adults enrolled in the Botswana Antiretroviral Treatment Program in 2002. Data analysis was conducted on available longitudinal data up to 1st April 2007.

Results: Six hundred thirty-three severely immunodeficient patients with a median CD4+ cell count of 67 cells/μl were initiated on non-nucleoside reverse transcriptase inhibitor-based combination ART and followed for a median of 41.9 months. The median CD4+ cell count increases were 169, 302, and 337 cells/μl at 1, 3, and 5 years, respectively. The percentages of patients with a viral load of less than 400 copies/ml at 1, 3, and 5 years were 91.3, 90.1, and 98.3%, respectively. Seventy-five percent of patients did not miss a single, or missed only one, monthly ART pickup per year with a mean pickup rate of 92.5%. The Kaplan–Meier survival estimates [95% confidence interval (CI)] at 1, 3, and 5 years were 82.7% (81.2 and 84.3%), 79.3% (77.6 and 81.0%), and 79.0% (77.3 and 80.7%), respectively. At 6 months, the risk of treatment modification for anemia was 6.94% (5.9 and 8.0%) for cutaneous hypersensitivity reactions, 1.3% (0.8 and 1.7%), and 1.1% (0.7 and 1.6%) for hepatotoxicity.

Conclusion: This initial group of adults on ART in Botswana had excellent sustained immunologic, virologic, and clinical outcomes for up to 5 years of follow-up with low mortality among those surviving into the second year of ART.

aBotswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education (BHP), USA

bBotswana, Ministry of Health, USA

cBotswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education (BHP) – PEPFAR, USA

dHarvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts, USA.

Received 18 April, 2008

Revised 27 June, 2008

Accepted 4 July, 2008

Correspondence to Richard G. Marlink, MD, Harvard School of Public Health, 651 Huntington Avenue, FXB Room 635, Boston, MA 02143, USA. E-mail: marlink@hsph.harvard.edu

Copyright © 2008 Wolters Kluwer Health, Inc.