title: Combination Antiretroviral Therapy for HIV in Rwandan Adults: Clinical Outcomes and Impact on Reproductive Health up to 24 Months.
abstract: Adult women (n = 113) and men (n = 100) initiating combination antiretroviral therapy (cART) and women not yet eligible for cART (n = 199) in Kigali, Rwanda, were followed for 6-24 months between 2007 and 2010. In the cART groups, 21% of patients required a drug change due to side effects and 11% of patients had virological failure (defined as >1,000 HIV RNA copies/mL) after 12 months of cART. About a third of the pregnancies since HIV diagnosis were unintended. The proportion of women in the pre-cART group using modern contraception other than condoms (50%) was similar to women in the general population, but this proportion was only 25% in women initiating cART. Of the women who carried at least one pregnancy to term since having been diagnosed HIV-positive, a third reported to have participated in a prevention-of-mother-to-child-transmission (PMTCT, option A) intervention. Many patients were coinfected with herpes simplex virus type 2 (79-92%), human papillomavirus (38-53%), and bacterial sexually transmitted infections (STIs) with no differences between groups. We applaud the Rwandan government for having strengthened family planning and PMTCT services and for having introduced HPV vaccination in recent years, but additional work is needed to strengthen STI and HPV-related cancer screening and management in the HIV-positive population.
authors.affiliation: INTERACT Program, Kigali, Rwanda ; College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
authors.forename: Brenda
authors.initials: B
authors.lastname: Asiimwe-Kateera
authors.affiliation: Academic Medical Center (AMC), Department of Global Health and Amsterdam Institute for Global Health and Development (AIGHD), 1105 BM Amsterdam, Netherlands ; Department of Epidemiology and Biostatistics, VU University Medical Center, 1007 MB Amsterdam, Netherlands.
authors.forename: Nienke
authors.initials: N
authors.lastname: Veldhuijzen
authors.affiliation: Treatment and Research for AIDS Center (TRAC-Plus), Kigali, Rwanda.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Balinda
authors.affiliation: National Reference Laboratory, Kigali, Rwanda.
authors.forename: John
authors.initials: J
authors.lastname: Rusine
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Eagle
authors.affiliation: Kigali University Teaching Hospital, Kigali, Rwanda ; Rinda Ubuzima, Kigali, Rwanda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Vyankandondera
authors.affiliation: Kigali University Teaching Hospital, Kigali, Rwanda.
authors.forename: Julie
authors.initials: J
authors.lastname: Mugabekazi
authors.affiliation: Academic Medical Center (AMC), Department of Global Health and Amsterdam Institute for Global Health and Development (AIGHD), 1105 BM Amsterdam, Netherlands.
authors.forename: Pascale
authors.initials: P
authors.lastname: Ondoa
authors.affiliation: INTERACT Program, Kigali, Rwanda ; Academic Medical Center (AMC), Department of Global Health and Amsterdam Institute for Global Health and Development (AIGHD), 1105 BM Amsterdam, Netherlands ; Biomedical Research, Royal Tropical Institute, 1105 AZ Amsterdam, Netherlands.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Boer
authors.affiliation: Ministry of Health of Rwanda, Rwanda.
authors.forename: Anita
authors.initials: A
authors.lastname: Asiimwe
authors.affiliation: Academic Medical Center (AMC), Department of Global Health and Amsterdam Institute for Global Health and Development (AIGHD), 1105 BM Amsterdam, Netherlands.
authors.forename: Joep
authors.initials: J
authors.lastname: Lange
authors.affiliation: Academic Medical Center (AMC), Department of Global Health and Amsterdam Institute for Global Health and Development (AIGHD), 1105 BM Amsterdam, Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.affiliation: Academic Medical Center (AMC), Department of Global Health and Amsterdam Institute for Global Health and Development (AIGHD), 1105 BM Amsterdam, Netherlands ; Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK ; Rinda Ubuzima, Kigali, Rwanda.
authors.forename: Janneke
authors.initials: J
authors.lastname: van de Wijgert