title: Immunovirological outcomes and resistance patterns at 4 years of antiretroviral therapy use in HIV-infected patients in Cambodia.
abstract: OBJECTIVE
  To report immunovirological outcomes and resistance patterns in adults treated with triple combination antiretroviral therapy (cART) for 4 years in an HIV programme of Phnom Penh, Cambodia.
  
  
  METHODS
  It is a longitudinal study and cross-sectional evaluation of adults receiving cART for 4 years. CD4 cell counts and HIV-1 RNA were quantified, and resistance patterns were determined. Drug-related toxicity was assessed by clinicians and through laboratory testing.
  
  
  RESULTS
  After 4 years of cART start, the cumulative probability of retention in care was 0.80 and survival among patients not lost to follow-up was 0.85. A total of 349 patients (98% of eligible) participated in the cross-sectional evaluation. Ninety per cent were receiving first-line therapy, 29% stavudine- and 58% zidovudine-containing regimens (compared with 94% and 3% at cART initiation). Ninety-three per cent of patients were clinically asymptomatic, and severe lipodystrophy and dyslipidemia were diagnosed in 7.2% and 4.0%, respectively. Good treatment adherence was reported by 83% of patients. Median CD4 T-cell count was 410 cells/μl [IQR 290-511], and 90% of patients had >200 cells/μl. Only 15 (4%) patients had detectable HIV viral load (eight had <200 CD4 cells/μl), five had thymidine analogue mutations, and nine were resistant to two drug classes. In an intention-to-treat analysis, 26.1% (95% CI 22.0-30.5) of patients had failed first-line therapy.
  
  
  CONCLUSIONS
  In this Cambodian cohort of adults who started cART at an advanced stage of HIV disease, we observed good clinical and immunovirological outcomes and self-reported treatment adherence at 4 years of therapy.
authors.affiliation: Epicentre, Paris, France. mar.pujades@epicentre.msf.org
authors.forename: Mar
authors.initials: M
authors.lastname: Pujades-Rodríguez
authors.forename: Birgit
authors.initials: B
authors.lastname: Schramm
authors.forename: Leakena
authors.initials: L
authors.lastname: Som
authors.forename: Eric
authors.initials: E
authors.lastname: Nerrienet
authors.forename: Prak
authors.initials: P
authors.lastname: Narom
authors.forename: Ngeth
authors.initials: N
authors.lastname: Chanchhaya
authors.forename: Laurent
authors.initials: L
authors.lastname: Ferradini
authors.forename: Suna
authors.initials: S
authors.lastname: Balkan
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D015397:Program Evaluation; D012367:RNA, Viral / Q000097:blood; D017211:Treatment Failure; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral