The Senegalese government's highly active antiretroviral therapy initiative: an 18-month follow-up study.
OBJECTIVE
To study the feasibility, effectiveness, adherence, toxicity and viral resistance in an African government HAART initiative.


METHODS
A prospective observational cohort study started in Dakar in August 1998. Initial treatment consisted of two nucleoside reverse transcriptase inhibitors and one protease inhibitor. The patients attended monthly medical examinations. Plasma HIV-1 RNA and CD4 cell counts were determined at baseline and every 6 months. Intention-to-treat analyses were performed.


RESULTS
Fifty-eight treatment-naive patients, mostly infected by HIV-1 strain CRF02-AG, were enrolled. Most were at an advanced stage of HIV disease (86.2% had AIDS). Adherence was good in 87.9% of patients and treatment was effective in most of them. Thus, HIV-1 RNA was undetectable in 79.6, 71.2, 51.4 and 59.3% of patients at months 1, 6, 12 and 18, respectively and the median viral load reduction was approximately 2.5 log10 copies/ml. The CD4 cell count rose by a median of 82, 147 and 180 x 106 cells/l at months 6, 12 and 18, respectively. At the same time points, the cumulative probability of remaining alive or free of new AIDS-defining events was 94.8, 85.0 and 82.3%. Most adverse effects (80.8%) were mild or moderate and only two cases of drug resistance occurred.


CONCLUSIONS
This study shows that HAART is feasible and well tolerated in African patients. Clinical and biological results were comparable to those seen in western cohorts, despite differences in the HIV-1 subtype distribution and an advanced disease stage when the treatment was initiated. Contrary to other recent studies in Africa, viral resistance rarely emerged.
Institut de Recherche pour le Développement (UR 36) and University of Montpellier, France.
Christian
C
Laurent
Ndella
N
Diakhaté
Ndeye Fatou Ngom
NF
Gueye
Mame Awa
MA
Touré
Papa Salif
PS
Sow
Mame Awa
MA
Faye
Mandoumbé
M
Gueye
Isabelle
I
Lanièce
Coumba
C
Touré Kane
Florian
F
Liégeois
Laurence
L
Vergne
Souleymane
S
Mboup
Salif
S
Badiane
Ibrahima
I
Ndoye
Eric
E
Delaporte
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D024882:Drug Resistance, Viral; D005240:Feasibility Studies; D005260:Female; D006078:Government Programs; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012675:Senegal; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral