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Resultados inmunovirológicos y patrones de resistencia tras cuatro años de terapia antirretroviral en pacientes infectados con VIH en Camboya
Author(s) -
PujadesRodríguez Mar,
Schramm Birgit,
Som Leakena,
Nerrienet Eric,
Narom Prak,
Chanchhaya Ngeth,
Ferradini Laurent,
Balkan Suna
Publication year - 2011
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2010.02689.x
Subject(s) - medicine , cart , lipodystrophy , stavudine , zidovudine , asymptomatic , antiretroviral therapy , viral load , cohort , human immunodeficiency virus (hiv) , immunology , viral disease , engineering , mechanical engineering
Summary Objectives To report immunovirological outcomes and resistance patterns in adults treated with triple combination antiretroviral therapy (cART) for 4 years in an HIV programme of Phnom Penh, Cambodia. Methods It is a longitudinal study and cross‐sectional evaluation of adults receiving cART for 4 years. CD4 cell counts and HIV‐1 RNA were quantified, and resistance patterns were determined. Drug‐related toxicity was assessed by clinicians and through laboratory testing. Results After 4 years of cART start, the cumulative probability of retention in care was 0.80 and survival among patients not lost to follow‐up was 0.85. A total of 349 patients (98% of eligible) participated in the cross‐sectional evaluation. Ninety per cent were receiving first‐line therapy, 29% stavudine‐ and 58% zidovudine‐containing regimens (compared with 94% and 3% at cART initiation). Ninety‐three per cent of patients were clinically asymptomatic, and severe lipodystrophy and dyslipidemia were diagnosed in 7.2% and 4.0%, respectively. Good treatment adherence was reported by 83% of patients. Median CD4 T‐cell count was 410 cells/μl [IQR 290–511], and 90% of patients had >200 cells/μl. Only 15 (4%) patients had detectable HIV viral load (eight had <200 CD4 cells/μl), five had thymidine analogue mutations, and nine were resistant to two drug classes. In an intention‐to‐treat analysis, 26.1% (95% CI 22.0–30.5) of patients had failed first‐line therapy. Conclusions In this Cambodian cohort of adults who started cART at an advanced stage of HIV disease, we observed good clinical and immunovirological outcomes and self‐reported treatment adherence at 4 years of therapy.