African and Asian cohort studies have demonstrated the feasibility and efficacy of HAART in resource-poor settings. The long-term virological outcome and clinico-immunological criteria of success remain important questions. We report the outcomes at 24 months of antiretroviral therapy (ART) in patients treated in a Médecins Sans Frontières/Ministry of Health programme in Cambodia.
Adults who started HAART 24 ± 2 months ago were included. Plasma HIV-RNA levels were assessed by real-time polymerase chain reaction. Factors associated with virological failure were analysed using logistic regression.
Of 416 patients, 59.2% were men; the median age was 33.6 years. At baseline, 95.2% were ART naive, 48.9% were at WHO stage IV, and 41.6% had a body mass index less than 18 kg/m2. The median CD4 cell count was 11 cells/μl. A stavudine–lamivudine–efavirenz-containing regimen was initiated predominantly (81.0%). At follow-up (median 23.8 months), 350 (84.1%) were still on HAART, 53 (12.7%) had died, six (1.4%) were transferred, and seven (1.7%) were lost to follow-up. Estimates of survival were 85.5% at 24 months. Of 346 tested patients, 259 (74.1%) had CD4 cell counts greater than 200 cells/μl and 306 (88.4%) had viral loads of less than 400 copies/ml. Factors associated with virological failure at 24 months were non-antiretroviral naive, an insufficient CD4 cell gain of less than 350 cells/μl or a low trough plasma ART concentration. In an intention-to-treat analysis, 73.6% of patients were successfully treated.
Positive results after 2 years of advanced HIV further demonstrate the efficacy of HAART in the medium term in resource-limited settings.
From the aEpicentre, Paris, France
bMédecins Sans Frontières, Paris, France
cImmunological Department, Georges Pompidou, European Hospital, Paris, France
dInfectious Disease Department, Khmero-Sovietic Friendship Hospital, Phnom Penh, Cambodia
eClinical Pharmacy Department, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, France
fInstitut Pasteur du Cambodia, Phnom Penh, Cambodia
gHIV/Hepatitis laboratory, CHU Necker, EA 3620 Université Paris-Descartes, Paris, France
hClinical Immunology Department, Bicêtre Hospital, Kremlin Bicêtre, France
iAgence Nationale de Recherches sur le Sida, Paris, France.
Received 11 February, 2007
Revised 7 May, 2007
Accepted 11 May, 2007
Correspondence to Laurent Ferradini, Médecins Sans Frontières, 8 rue Saint-Sabin, 75011 Paris, France. E-mail: firstname.lastname@example.org