title: Longer term clinical and virological outcome of sub-Saharan African participants on antiretroviral treatment in the Swiss HIV Cohort Study.
abstract: OBJECTIVE
  Persons from sub-Saharan Africa (SSA) are increasingly enrolled in the Swiss HIV Cohort Study (SHCS). Cohorts from other European countries showed higher rates of viral failure among their SSA participants. We analyzed long-term outcomes of SSA versus North Western European participants.
  
  
  METHODS
  We analyzed data of the SHCS, a nation-wide prospective cohort study of HIV-infected adults at 7 sites in Switzerland.
  
  
  METHODS
  SSA and North Western European participants were included if their first treatment combination consisted of at least 3 antiretroviral drugs (cART), if they had at least 1 follow-up visit, did not report active injecting drug use, and did not start cART with CD4 counts >200 cells per microliter during pregnancy. Early viral response, CD4 cell recovery, viral failure, adherence, discontinuation from SHCS, new AIDS-defining events, and survival were analyzed using linear regression and Cox proportional hazard models.
  
  
  RESULTS
  The proportion of participants from SSA within the SHCS increased from 2.6% (<1995) to 20.8% (2005-2009). Of 4656 included participants, 808 (17.4%) were from SSA. Early viral response (6 months) and rate of viral failure in an intent-to-stay-on-cART approach were similar. However, SSA participants had a higher risk of viral failure on cART (adjusted hazard ratio: 2.03, 95% confidence interval: 1.50 to 2.75). Self-reported adherence was inferior for SSA. There was no increase of AIDS-defining events or mortality in SSA participants.
  
  
  CONCLUSIONS
  Increased attention must be given to factors negatively influencing adherence to cART in participants from SSA to guarantee equal longer-term results on cART.
authors.affiliation: Clinic for Infectious Diseases, Bern University Hospital, Switzerland. cornelia.staehelin@insel.ch
authors.forename: Cornelia
authors.initials: C
authors.lastname: Staehelin
authors.forename: Olivia
authors.initials: O
authors.lastname: Keiser
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
authors.forename: Luigia
authors.initials: L
authors.lastname: Elzi
authors.forename: Matthias
authors.initials: M
authors.lastname: Cavassini
authors.forename: Patrick
authors.initials: P
authors.lastname: Schmid
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044383:Black People; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects; D044465:White People
chemical_list: D019380:Anti-HIV Agents