title: Long-term virological, immunological and mortality outcomes in a cohort of HIV-infected female sex workers treated with highly active antiretroviral therapy in Africa.
abstract: BACKGROUND
  Concerns have been raised that marginalised populations may not achieve adequate compliance to antiretroviral therapy. Our objective was to describe the long-term virological, immunological and mortality outcomes of providing highly active antiretroviral therapy (HAART) with strong adherence support to HIV-infected female sex workers (FSWs) in Burkina Faso and contrast outcomes with those obtained in a cohort of regular HIV-infected women.
  
  
  METHODS
  Prospective study of FSWs and non-FSWs initiated on HAART between August 2004 and October 2007. Patients were followed monthly for drug adherence (interview and pill count), and at 6-monthly intervals for monitoring CD4 counts and HIV-1 plasma viral loads (PVLs) and clinical events.
  
  
  RESULTS
  95 women, including 47 FSWs, were followed for a median of 32 months (interquartile range [IQR], 20-41). At HAART initiation, the median CD4 count was 147 cells/μl (IQR, 79-183) and 144 cells/μl (100-197), and the mean PVLs were 4.94 log10 copies/ml (95% confidence interval [CI], 4.70-5.18) and 5.15 log10 copies/ml (4.97-5.33), in FSWs and non-FSWs, respectively. Four FSWs died during follow-up (mortality rate: 1.7 per 100 person-years) and none among other women. At 36 months, the median CD4 count increase was 230 cells/μl (IQR, 90-400) in FSWs vs. 284 cells/μl (193-420) in non-FSWs; PVL was undetectable in 81.8% (95% CI, 59.7-94.8) of FSWs vs. 100% (83.9-100) of non-FSWs; and high adherence to HAART (> 95% pills taken) was reported by 83.3% (95% CI, 67.2-93.6), 92.1% (95% CI, 78.6-98.3), and 100% (95% CI, 54.1-100) of FSWs at 6, 12, and 36 months after HAART initiation, respectively, with no statistical difference compared to the pattern observed among non-FSWs.
  
  
  CONCLUSIONS
  Clinical and biological benefits of HAART can be maintained over the long-term among FSWs in Africa and could also lead to important public health benefits.
authors.affiliation: London School of Hygiene & Tropical Medicine (LSHTM), London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Huet
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Ouedraogo
authors.forename: Issouf
authors.initials: I
authors.lastname: Konaté
authors.forename: Isidore
authors.initials: I
authors.lastname: Traore
authors.forename: François
authors.initials: F
authors.lastname: Rouet
authors.forename: Antoinette
authors.initials: A
authors.lastname: Kaboré
authors.forename: Anselme
authors.initials: A
authors.lastname: Sanon
authors.forename: Philippe
authors.initials: P
authors.lastname: Mayaud
authors.forename: Philippe
authors.initials: P
authors.lastname: Van de Perre
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nagot
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002050:Burkina Faso / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000821:virology; D006801:Humans; D007407:Interviews as Topic; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011446:Prospective Studies; D060386:Sex Workers; D019562:Viral Load