Treatment outcome of HAART-treated patients in a resource-limited setting: The Belgrade Cohort Study

• Published in: Biomedicine & pharmacotherapy 2014-04, Vol.68 (3), p.391-395
• Main Authors: Jevtović, Djordje, Dragovic, Gordana, Salemović, Dubravka, Ranin, Jovan, Kušić, Jovana, Marinković, Jelena, Djurković-Djaković, Olgica
• Format: Article
• Language: English
• Subjects: Adult; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - supply & distribution; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy, Highly Active - statistics & numerical data; CD4 Lymphocyte Count; Cohort Studies; Cross-Sectional Studies; Disease-Free Survival; Female; HAART; Health Services Accessibility; HIV; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; Humans; Internal Medicine; Male; Medical Education; Middle Aged; Predictive Value of Tests; Proportional Hazards Models; Resource limited settings; RNA, Viral - blood; Serbia; Survival; Treatment Outcome; Viral Load
• ISSN: 0753-3322; 1950-6007
• DOI: 10.1016/j.biopha.2014.01.001

Abstract Introduction 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 350 cells/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 ± 3.4 years. 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). Conclusion 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.