Treatment outcome of HAART-treated patients in a resource-limited setting: the Belgrade Cohort Study.
BACKGROUND
We evaluated the effects of highly-active-antiretroviral-therapy (HAART) in a resource-limited settings.


METHODS
A cross-sectional study was performed in patients who had initiated HAART at the HIV/AIDS-Center, Belgrade, Serbia. Treatment response was considered favorable in case of the achievement of undetectable HIVRNA plasma-viral-load (pVL<50 copies/μL), and with the CD4+ T-cell counts increased above 350cells/μL. The treatment failure was defined as pVL over 1.7 log10 copies/mL, regardless of immunological improvement.


RESULTS
Eight hundred and forty HIV infected patients were followed-up for 8.2±3.4years. Out of 697 patients available for follow-up, 113 (16.2%) patients died, 44 (6.3%) experienced treatment failure, while 540 (77.5%) had sustained undetectable viremia. In 419 (60.1%) favorable treatment response was achieved, while the dissociation between immunological and virological responses to HAART occurred in 121 (14.4%). A baseline CD4+ T-cell counts above 200 cells/μL was the single independent predictor of a favorable treatment response (HR=2, 95%CI=1.69-2.61, P=0.001), while pre-treatment with ART, HCV co-infection and AIDS at the time of treatment initiation, were all factors preventing a favorable response (HR=0.27, 95%CI=0.19-0.36, P=0.001; HR=0.75, 95%CI=0.56-0.95, P=0.02; HR=0.73, 95%CI=0.17-0.95, P=0.018, respectively). A sustained viral suppression was an independent predictor of survival (HR=0.2, 95% CI 0.07-0.61, P=0.004). HAART treated HIV-infected patients who reach and maintain undetectable viremia, have an 80% probability of a 14-years survival (P=0.08, log-rank).


CONCLUSIONS
If patient with advanced HIV-related immunodeficiency reach and maintain optimal viral suppression during HAART, regardless of the level of immune recovery, and if they continue to maintain this, their prognosis may be fairly good even in the resource-limited settings.
Infectious and Tropical Diseases Hospital, HIV/AIDS Department, University of Belgrade School of Medicine, Clinical Center of Serbia, Bulevar Oslobodjenja 16, 11000 Belgradee, Serbia. Electronic address: djordje.jevtovic@med.bg.ac.rs.
Djordje
D
Jevtović
Institute for Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Dr Subotica1/III, P.O. Box 38, 11129 Belgrade, Serbia. Electronic address: gozza@beotel.net.
Gordana
G
Dragovic
Infectious and Tropical Diseases Hospital, HIV/AIDS Department, University of Belgrade School of Medicine, Clinical Center of Serbia, Bulevar Oslobodjenja 16, 11000 Belgradee, Serbia.
Dubravka
D
Salemović
Infectious and Tropical Diseases Hospital, HIV/AIDS Department, University of Belgrade School of Medicine, Clinical Center of Serbia, Bulevar Oslobodjenja 16, 11000 Belgradee, Serbia.
Jovan
J
Ranin
Infectious and Tropical Diseases Hospital, HIV/AIDS Department, University of Belgrade School of Medicine, Clinical Center of Serbia, Bulevar Oslobodjenja 16, 11000 Belgradee, Serbia.
Jovana
J
Kušić
Institute for Medical Statistics, School of Medicine, University of Belgrade, Belgrade, Serbia.
Jelena
J
Marinković
Institute for Medical Research, University of Belgrade School of Medicine, Belgrade, Serbia.
Olgica
O
Djurković-Djaković
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000600:supply & distribution* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D018572:Disease-Free Survival; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood; D055771:Serbia; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral
HAART; HIV; Resource limited settings; Survival