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Virologic and immunologic outcomes and programmatic challenges
of an antiretroviral treatment pilot project in Abidjan, Cote d'Ivoire.
AIDS 2003;17(Suppl 3):S5-S15.
Djomand G, Roels T, Ellerbrock T, Hanson D, Diomande F, Monga B, Maurice
C, Nkengasong J, Konan-koko R, Kadio A, Wiktor S, Lackritz E, Saba J,
Chorba T.
Abstract
BACKGROUND: In Cobte d'Ivoire, a pilot project was developed by UNAIDS and
the Ministry of Health to improve access to AIDS care, including antiretroviral
therapy, for adults and children infected with HIV. This evaluation of the
project is the first to provide results of a large number of HIV-infected
patients receiving antiretroviral therapy in West Africa. METHODS: We evaluated
records of persons who presented for care from August 1998 to August 2000
at six accredited centers in Abidjan. Patients were treated with two nucleoside
reverse transcriptase inhibitors (2NRTI) or highly active antiretroviral
therapy (HAART). RESULTS: Of 2878 patients who were screened, 2351 (83%)
were HIV-infected and eligible (CD4 T lymphocyte count < 500 x 10(6) cells/l
or plasma HIV-RNA level > 10 000 copies/ml) for antiretroviral therapy.
Of those who were eligible, 81% were symptomatic, 63% had a CD4 cell count < 200
x 10(6) cells/l, 12% had previously taken antiretroviral drugs, and 56% returned
to the clinic for follow-up. Of the patients screened, 768 (27%) were started
on antiretroviral therapy, including 450 on HAART, 296 on 2NRTI, and 22 on
other regimens. We analyzed data from 480 HIV-1-infected adults, who were
naive to therapy, were prescribed HAART or 2NRTI, and had at least one clinic
visit after starting therapy. In an intent-to-treat analysis of patients
who received HAART, the estimated plasma HIV-1 RNA level was approximately
1.9 log10 copies/ml (80-fold) lower, while estimated CD4 cell count was > 100
x 10(6) cells/l higher than baseline values, after 1 year of therapy. Approximately
25% of adults on 2NRTI and 50% of those on HAART had < 200 copies/ml,
after 1 year of therapy. The probability of an adverse event occurring within
6 months after starting therapy was 0.20. The probability of survival for
at least 1 year was 0.84 (95% confidence interval, 0.80-0.89). CONCLUSION:
After starting antiretroviral therapy, these HIV-1-infected patients in West
Africa had similar virologic and immunologic outcomes, probability of an
adverse event, and estimated survival, as patients enrolled in clinical trials
in the USA and Europe. However, only one-third of eligible patients received
therapy, highlighting the importance of providing adequate education and
support for initiating and adhering to therapy in this and similar programmes.