Long-term benefits of highly active antiretroviral therapy in Senegalese HIV-1-infected adults.
OBJECTIVE
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%).


CONCLUSIONS
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.
Laurent
Christian
C
Institut de Recherche pour le Développement and Department of International Health, University of Montpellier (UMR 145), France. Christian.Laurent@mpl.ird.fr
Ngom Gueye
Ndeye Fatou
NF
Ndour
Cheikh Tidiane
CT
Gueye
Pape Mandoumbé
PM
Diouf
Martin
M
Diakhaté
Ndella
N
Touré Kane
Ndeye Coumba
NC
Lanièce
Isabelle
I
Ndir
Adama
A
Vergne
Laurence
L
Ndoye
Ibrahima
I
Mboup
Souleymane
S
Sow
Pape Salif
PS
Delaporte
Eric
E
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012675:Senegal / Q000453:epidemiology; D013997:Time Factors