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Long-term Experience and Outcomes of Programmatic Antiretroviral Therapy for Human Immunodeficiency Virus Type 2 Infection in Senegal, West Africa

2020; Oxford University Press; Volume: 72; Issue: 3 Linguagem: Inglês

10.1093/cid/ciaa277

1537-6591

Dana N. Raugi, Selly Ba, Ousseynou Cisse, Khardiata Diallo, Ibrahima Tito Tamba, Cheikh Tidiane Ndour, Ndèye Méry Dia Badiane, Louise Fortes, Mouhamadou Baïla Diallo, Dominique Faye, Robert A. Smith, Fatima Sall, Macoumba Touré, ElHadji Ibrahima Sall, Habibatou Diallo Agne, Khadim Faye, Jean Philippe Diatta, Marie Pierre Sy, Ming Chang, Binetou Diaw, Jacques F. Sambou, Raphael Bakhoum, Mame Demba Sy, Alassane Niang, Jean Jacques Malomar, Robert W. Coombs, Stephen E. Hawes, Ibra Ndoye, Nancy B. Kiviat, Papa Salif Sow, Moussa Seydi, Geoffrey S. Gottlieb, Fatou Traoré, Samba Cisse, Ousseynou Ndiaye, Babacar Faye, Fatou Simal, Ndeye Astou Diop, Amadou Bale Diop, Marianne Fadam Diome, Juliette Gomis, Therese Dieye, Noelle A. Benzekri, John Lin, Donna Kenney, Alison K. Starling, Cathy W. Critchlow, Steve Cherne, Jennifer Song, Robbie Nixon, Pallas Burhen, Chris Zavala, Vincent H. Wu, Sara Masoum, Sally Leong, Alex Montano, Mariah Oakes, Julia Olson, Lindsey Blankenship, Charlotte Pan, Kara Parker, Kate Parker, Alex Hernandez, Brad Church, Moon Kim, Paul M. Lu, Stefanie Sorensen, Kim Wong, James I. Mullins,

HIV/AIDS drug development and treatment

Abstract Background Programmatic treatment outcome data for people living with human immunodeficiency virus type 2 (HIV-2) in West Africa, where the virus is most prevalent, are scarce. Methods Adults with HIV-2 initiating or receiving antiretroviral therapy (ART) through the Senegalese national AIDS program were invited to participate in this prospective, longitudinal observational cohort study. We analyzed HIV-2 viral loads, CD4 cell counts, antiretroviral drug resistance, loss to follow-up, and mortality. We also examined changes in treatment guidelines over time and assessed progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets for HIV-2. Results We enrolled 291 participants at 2 sites for 926.0 person-years of follow-up over 13 years. Median follow-up time was 2.2 years per participant. There were 21 deaths reported (7.2%), and 117 individuals (40.2%) were lost to follow-up, including 43 (14.7%) who had an initial visit but never returned for follow-up. CD4 counts and HIV-2 viral suppression (< 50 copies/mL) at enrollment increased over calendar time. Over the study period, 76.7% of plasma viral loads for participants receiving ART were suppressed, and median CD4 gain was 84 cells/μL in participants’ first 2 years on study. Since the UNAIDS 90-90-90 strategy was published, 88.1% of viral loads were suppressed. Fifteen percent of patients experienced virologic failure with no known resistance mutations, while 56% had evidence of multiclass drug resistance. Conclusions Participants in the Senegalese national AIDS program are initiating ART earlier in the course of disease, and more modern therapeutic regimens have improved outcomes among those receiving therapy. Despite these achievements, HIV-2 treatment remains suboptimal, and significant challenges to improving care remain.