title: Short communication: three years follow-up of first-line antiretroviral therapy in cambodia: negative impact of prior antiretroviral treatment.
abstract: There are few long-term data on ART-experienced patients in resource-limited settings. We performed a cross-sectional study of HIV-infected patients included in the ESTHER program in Calmette hospital, Phnom Penh, Cambodia, after 36 ± 3 months of cART. Therapeutic, clinical, and immunovirological outcomes were compared between patients who stated they were ART-naive (naive group), dual nucleoside reverse-transcriptase inhibitor (two-NRTI group), or fixed-dose combination of stavudine/lamivudine/nevirapine experienced (three-drug group) at entry to the program. A logistic regression model was used to evaluate the factors associated with virological failure (PCR HIV > 250 copies/ml). Among the 256 patients included in the analysis, 148 (58%) were ART naive while 50 (20%) had previously received two NRTIs and 58 (22%) three drugs. At entry to the program, all the patients received two NRTIs and one nonnucleoside reverse-transcriptase inhibitor (NNRTI). At evaluation, 46 patients (18%) were switched to a protease inhibitor-based regimen (9%, 32%, and 29% of the naive, two-NRTI, and three-drug groups; p < 0.0001). The median CD4 cell count increase was 180/μl overall (IQR: 96-276) and was higher in ART-naive than ART-experienced patients. In the intent-to-treat analysis, virological success was achieved in 83.5%, 67%, and 69% of the naive, two-NRTI, and three-drug groups, respectively (p = 0.002). Factors associated with virological failure were suboptimal previous ART exposure and WHO immunological failure criteria. The long-term efficacy of first-line cART is maintained in Cambodia. In ART-experienced patients, viral load monitoring needs to be available to establish early virological failure and preserve the potency of second line regimens.
authors.affiliation: Department of Medicine, Bicêtre Hospital, Le Kremlin Bicêtre, France. oliseg@hotmail.com
authors.forename: Olivier
authors.initials: O
authors.lastname: Ségéral
authors.forename: Setha
authors.initials: S
authors.lastname: Limsreng
authors.forename: Janin
authors.initials: J
authors.lastname: Nouhin
authors.forename: ChanRoeurn
authors.initials: C
authors.lastname: Hak
authors.forename: Sopheak
authors.initials: S
authors.lastname: Ngin
authors.forename: Marc
authors.initials: M
authors.lastname: De Lavaissière
authors.forename: Cécile
authors.initials: C
authors.lastname: Goujard
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Taburet
authors.forename: Eric
authors.initials: E
authors.lastname: Nerrienet
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Delfraissy
authors.forename: Vara
authors.initials: V
authors.lastname: Ouk
authors.forename: Anne
authors.initials: A
authors.lastname: Dulioust
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D002160:Cambodia; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D012307:Risk Factors; D017211:Treatment Failure; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents