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The Senegalese government's highly active antiretroviral therapy initiative: an 18-month follow-up study

2002; Lippincott Williams & Wilkins; Volume: 16; Issue: 10 Linguagem: Inglês

10.1097/00002030-200207050-00008

1473-5571

Christian Laurent, Ndella Diakhaté, Ndèye Fatou Ngom Gueye, Mame Awa Touré, Papa Salif Sow, Mame Awa Faye, Mandoumbe Guèye, Isabelle Lanièce, Coumba Touré Kane, Florian Liégeois, Laurence Vergne, Souleymane Mboup, Salif Badiane, Ibrahima Ndoye, Éric Delaporte,

HIV/AIDS Research and Interventions

Objective To study the feasibility, effectiveness, adherence, toxicity and viral resistance in an African government HAART initiative. Methods A prospective observational cohort study started in Dakar in August 1998. Initial treatment consisted of two nucleoside reverse transcriptase inhibitors and one protease inhibitor. The patients attended monthly medical examinations. Plasma HIV-1 RNA and CD4 cell counts were determined at baseline and every 6 months. Intention-to-treat analyses were performed. Results Fifty-eight treatment-naive patients, mostly infected by HIV-1 strain CRF02-AG, were enrolled. Most were at an advanced stage of HIV disease (86.2% had AIDS). Adherence was good in 87.9% of patients and treatment was effective in most of them. Thus, HIV-1 RNA was undetectable in 79.6, 71.2, 51.4 and 59.3% of patients at months 1, 6, 12 and 18, respectively and the median viral load reduction was ∼2.5 log10 copies/ml. The CD4 cell count rose by a median of 82, 147 and 180 × 106 cells/l at months 6, 12 and 18, respectively. At the same time points, the cumulative probability of remaining alive or free of new AIDS-defining events was 94.8, 85.0 and 82.3%. Most adverse effects (80.8%) were mild or moderate and only two cases of drug resistance occurred. Conclusion This study shows that HAART is feasible and well tolerated in African patients. Clinical and biological results were comparable to those seen in western cohorts, despite differences in the HIV-1 subtype distribution and an advanced disease stage when the treatment was initiated. Contrary to other recent studies in Africa, viral resistance rarely emerged.