Five-year outcomes of initial patients treated in Botswana's National Antiretroviral Treatment Program.
BACKGROUND
Antiretroviral treatment (ART) initiatives have now been established in many sub-Saharan African countries showing early benefits. To date, few results are available concerning long-term clinical outcomes in these treatment programs.


METHODS
Response to ART is described in the first HIV-1C-infected adults enrolled in the Botswana Antiretroviral Treatment Program in 2002. Data analysis was conducted on available longitudinal data up to 1st April 2007.


RESULTS
Six hundred thirty-three severely immunodeficient patients with a median CD4+ cell count of 67 cells/microl were initiated on non-nucleoside reverse transcriptase inhibitor-based combination ART and followed for a median of 41.9 months. The median CD4+ cell count increases were 169, 302, and 337 cells/microl at 1, 3, and 5 years, respectively. The percentages of patients with a viral load of less than 400 copies/ml at 1, 3, and 5 years were 91.3, 90.1, and 98.3%, respectively. Seventy-five percent of patients did not miss a single, or missed only one, monthly ART pickup per year with a mean pickup rate of 92.5%. The Kaplan-Meier survival estimates [95% confidence interval (CI)] at 1, 3, and 5 years were 82.7% (81.2 and 84.3%), 79.3% (77.6 and 81.0%), and 79.0% (77.3 and 80.7%), respectively. At 6 months, the risk of treatment modification for anemia was 6.94% (5.9 and 8.0%) for cutaneous hypersensitivity reactions, 1.3% (0.8 and 1.7%), and 1.1% (0.7 and 1.6%) for hepatotoxicity.


CONCLUSIONS
This initial group of adults on ART in Botswana had excellent sustained immunologic, virologic, and clinical outcomes for up to 5 years of follow-up with low mortality among those surviving into the second year of ART.
Bussmann
Hermann
H
Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education, Department of Immunology and Infectious Diseases, Boston, Massachusetts, USA.
Wester
C William
CW
Ndwapi
Ndwapi
N
Grundmann
Nicolas
N
Gaolathe
Tendani
T
Puvimanasinghe
John
J
Avalos
Ava
A
Mine
Madisa
M
Seipone
Khumo
K
Essex
Max
M
Degruttola
Victor
V
Marlink
Richard G
RG
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D001902:Botswana; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D024882:Drug Resistance, Viral / Q000276:immunology; D005260:Female; D006078:Government Programs / Q000592:standards; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D015497:HIV-1; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D015397:Program Evaluation; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
D018894:Reverse Transcriptase Inhibitors