OBJECTIVES: To assess the long-term survival, as well as the immunologic and virologic effectiveness, adherence, and drug resistance, in HIV-infected patients receiving highly active antiretroviral therapy (HAART) in one of the oldest and best-documented African cohorts. METHODS: A prospective observational cohort study included the first 176 HIV-1-infected adults followed in the Senegalese government-sponsored antiretroviral therapy initiative launched in August 1998. Patients were followed for a median of 30 months (interquartile range, 21-36 months). HAART comprised 2 nucleoside reverse transcriptase inhibitors and either 1 protease inhibitor or 1 nonnucleoside reverse transcriptase inhibitor. RESULTS: At baseline, 92% of patients were antiretroviral naive and 82% had AIDS; the median CD4 count was 144 cells/mm, and median viral load was 202,368 copies/mL. The survival probability was high (0.81 at 3 years; 95% CI, 0.74-0.86) and was independently related to a baseline hemoglobin level <10 g/dL and a Karnofsky score <90%. Antiviral efficacy was consistently observed during the 3 years of treatment (-2.5 to -3.0 log10 copies/mL; 60-80% of patients with viral load <500 copies/mL) and the CD4 count increase reached a median of 225 cells/mm. Most patients reported good adherence (80-90%). The emergence of drug resistance was relatively rare (12.5%). CONCLUSION: This study shows that clinical and biologic results similar to those seen in Western countries can be achieved and sustained during the long term in Africa.
OBJECTIVES: To assess the long-term survival, as well as the immunologic and virologic effectiveness, adherence, and drug resistance, in HIV-infectedpatients receiving highly active antiretroviral therapy (HAART) in one of the oldest and best-documented African cohorts. METHODS: A prospective observational cohort study included the first 176 HIV-1-infected adults followed in the Senegalese government-sponsored antiretroviral therapy initiative launched in August 1998. Patients were followed for a median of 30 months (interquartile range, 21-36 months). HAART comprised 2 nucleoside reverse transcriptase inhibitors and either 1 protease inhibitor or 1 nonnucleoside reverse transcriptase inhibitor. RESULTS: At baseline, 92% of patients were antiretroviral naive and 82% had AIDS; the median CD4 count was 144 cells/mm, and median viral load was 202,368 copies/mL. The survival probability was high (0.81 at 3 years; 95% CI, 0.74-0.86) and was independently related to a baseline hemoglobin level <10 g/dL and a Karnofsky score <90%. Antiviral efficacy was consistently observed during the 3 years of treatment (-2.5 to -3.0 log10 copies/mL; 60-80% of patients with viral load <500 copies/mL) and the CD4 count increase reached a median of 225 cells/mm. Most patients reported good adherence (80-90%). The emergence of drug resistance was relatively rare (12.5%). CONCLUSION: This study shows that clinical and biologic results similar to those seen in Western countries can be achieved and sustained during the long term in Africa.
Authors: Rochelle P Walensky; Milton C Weinstein; Yazdan Yazdanpanah; Elena Losina; Lauren M Mercincavage; Siaka Touré; Nomita Divi; Xavier Anglaret; Sue J Goldie; Kenneth A Freedberg Journal: AIDS Date: 2007-05-11 Impact factor: 4.177
Authors: Sheri D Weiser; David M Tuller; Edward A Frongillo; Jude Senkungu; Nozmu Mukiibi; David R Bangsberg Journal: PLoS One Date: 2010-04-28 Impact factor: 3.240
Authors: Sheila Isanaka; Ferdinand Mugusi; Claudia Hawkins; Donna Spiegelman; James Okuma; Said Aboud; Chalamilla Guerino; Wafaie W Fawzi Journal: JAMA Date: 2012-10-17 Impact factor: 56.272
Authors: Norma C Ware; John Idoko; Sylvia Kaaya; Irene Andia Biraro; Monique A Wyatt; Oche Agbaji; Guerino Chalamilla; David R Bangsberg Journal: PLoS Med Date: 2009-01-27 Impact factor: 11.069