Long-term outcomes of antiretroviral therapy in a large HIV/AIDS care clinic in urban South Africa: a prospective cohort study
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Sanne, Ian M, et al. Long-term Outcomes of Antiretroviral Therapy In a Large Hiv/aids Care Clinic In Urban South Africa: a Prospective Cohort Study. BioMed Central Ltd, 2009. https://doi.org/10.17615/xxpb-ym96APA
Sanne, I., Westreich, D., Macphail, A., Rubel, D., Majuba, P., & Van Rie, A. (2009). Long-term outcomes of antiretroviral therapy in a large HIV/AIDS care clinic in urban South Africa: a prospective cohort study. BioMed Central Ltd. https://doi.org/10.17615/xxpb-ym96Chicago
Sanne, Ian M, Daniel Westreich, Andrew P Macphail, Dennis Rubel, Pappie Majuba, and Annelies Van Rie. 2009. Long-Term Outcomes of Antiretroviral Therapy In a Large Hiv/aids Care Clinic In Urban South Africa: a Prospective Cohort Study. BioMed Central Ltd. https://doi.org/10.17615/xxpb-ym96- Creator
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Sanne, Ian M
- Other Affiliation: Clinical HIV Research Unit, Dept of Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Westreich, Daniel
- Affiliation: Gillings School of Global Public Health, Department of Epidemiology
- Other Affiliation: Clinical HIV Research Unit, Dept of Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Macphail, Andrew P
- Other Affiliation: Clinical HIV Research Unit, Dept of Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Rubel, Dennis
- Other Affiliation: Clinical HIV Research Unit, Dept of Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Majuba, Pappie
- Other Affiliation: Clinical HIV Research Unit, Dept of Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Van Rie, Annelies
- Affiliation: Gillings School of Global Public Health, Department of Epidemiology
- Other Affiliation: Clinical HIV Research Unit, Dept of Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Abstract
- Abstract Background Clinical, immunologic and virologic outcomes at large HIV/AIDS care clinics in resource poor settings are poorly described beyond the first year of highly active antiretroviral treatment (HAART). We aimed to prospectively evaluate long-term treatment outcomes at a large scale HIV/AIDS care clinic in South Africa. Methods Cohort study of patients initiating HAART between April 1, 2004 and March 13, 2007, and followed up until April 1, 2008 at a public HIV/AIDS care clinic in Johannesburg, South Africa. We performed time to event analysis on key treatment outcomes and program impact parameters including mortality, retention in care, CD4 count gain, virologic success and first line regimen durability. Results 7583 HIV-infected patients initiated care and contributed to 161,000 person months follow up. Overall mortality rate was low (2.9 deaths per 100 person years, 95% CI 2.6-3.2), but high in the first three months of HAART (8.4 per 100 person years, 95% CI 7.2-9.9). Long-term on-site retention in care was relatively high (74.4% at 4 years, 95%CI 73.2-75.6). CD4 count was above 200 cells/mm3 after 6 months of treatment in almost all patients. By the fourth year of HAART, the majority (59.6%, 95%CI 57.8-61.4) of patients had at least one first line drug (mainly stavudine) substituted. Women were twice as likely to experience drug substitution (OR 1.97, 95% CI 1.80-2.16). By 6 months of HAART, 90.8% suppressed virus below 400 copies. Among those with initial viral suppression, 9.4% (95% CI 8.5-10.3%) had viral rebound within one year of viral suppression, 16.8% (95% CI 15.5-18.1) within 2 years, and 20.6% (95% CI 18.9-22.4) within 3 years of initial suppression. Only 10% of women and 13% of men initiated second line HAART. Conclusion Despite advanced disease presentation and a very large-scale program, high quality care was achieved as indicated by good long-term clinical, immunologic and virologic outcomes and a low rate of second line HAART initiation. High rates of single drug substitution suggest that the public health approach to HAART could be further improved by the use of a more durable first line regimen.
- Date of publication
- December 17, 2009
- DOI
- Identifier
- Resource type
- Article
- Rights statement
- In Copyright
- Rights holder
- Ian M Sanne et al.; licensee BioMed Central Ltd.
- License
- Journal title
- Journal of the International AIDS Society
- Journal volume
- 12
- Journal issue
- 1
- Page start
- 38
- Language
- English
- Is the article or chapter peer-reviewed?
- Yes
- ISSN
- 1758-2652
- Bibliographic citation
- Journal of the International AIDS Society. 2009 Dec 17;12(1):38
- Publisher
- BioMed Central Ltd
- Access right
- Open Access
- Date uploaded
- August 23, 2012
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