Treatment as prevention in resource-limited settings: is it feasible to maintain HIV viral load suppression over time?
BACKGROUND
Recently, there has been increasing interest in the role of "treatment as prevention" (TasP). Some of the questions regarding TasP strategies arise from the perceived difficulties in achieving and maintaining viral load (VL) suppression over time and the risk of emergence of viral resistance that could compromise future treatment options. This study was conducted to assess these questions in a resource-limited setting.


METHODS
We performed a retrospective observational study of HIV-infected patients diagnosed in the pre-HAART era on follow-up at a private center from Buenos Aires, Argentina. Socio-demographic, clinical, and laboratory data were extracted from clinical charts. Analyses were performed to test for potential associations of selected variables with current virologic failure or use of third-line drugs.


RESULTS
Of 619 patients on follow-up, 82 (13.2%) were diagnosed in the pre-HAART era. At the time of our study, 79 (96.3%) patients were on HAART, with a median duration of 14 years (IQR 12-15) of therapy, and exposure to mono or dual nucleoside reverse transcriptase inhibitors regimens in 47.8% of cases. Sixty-nine patients (87.3%) had undetectable VL, 37 (46.8%) never presented virologic failure, and 19 (24.1%) experienced only one failure. Thirteen patients (16.5%) were receiving third-line ART regimens, with an average of 2.7-fold more virologic failures than those on first- or second-line regimens (p = 0.007).


CONCLUSIONS
Maintaining viral load suppression over time in resource-limited-settings is feasible.
Sanatorio Otamendi, Buenos Aires, Argentina. eugenia.socias@gmail.com
María Eugenia
ME
Socías
Flavio
F
Rotryng
Pablo
P
Lapadula
Maira
M
Medrano
Daniela
D
Paz
Liliana
L
Stern
Alberto
A
Lambierto
Daniel
D
Pryluka
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000494:pharmacology; D001118:Argentina; D018890:Chemoprevention / Q000379:methods*; D015331:Cohort Studies; D003906:Developing Countries; D024882:Drug Resistance, Viral; D005260:Female; D006678:HIV / Q000187:drug effects / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D017211:Treatment Failure; D019562:Viral Load; D055815:Young Adult
D019380:Anti-HIV Agents