Long-Term Outcome of an HIV-Treatment Programme in Rural Africa : Viral Suppression despite Early Mortality

Abstract EN

Objective.

To define the long-term (2–4 years) clinical and virological outcome of an antiretroviral treatment (ART) programme in rural South Africa.

Methods.

We performed a retrospective observational cohort study, including 735 patients who initiated ART.

Biannual monitoring, including HIV-RNA testing, was performed.

Primary endpoint was patient retention; virological suppression (HIV-RNA < 50 copies/mL) and failure (HIV-RNA > 1000 copies/mL) were secondary endpoints.

Moreover, possible predictors of treatment failure were analyzed.

Results.

63% of patients (466/735) have a fully suppressed HIV-RNA, a median of three years after treatment initiation.

Early mortality was high: 14% died within 3 months after treatment start.

16% of patients experienced virological failure, but only 4% was switched to second-line ART.

Male gender and a low performance score were associated with treatment failure; immunological failure was a poor predictor of virological failure.

Conclusions.

An “all or nothing” phenomenon was observed in this rural South African ART programme: high early attrition, but good virological control in those remaining in care.

Continued efforts are needed to enrol patients earlier.

Furthermore, the observed viro-immunological dissociation emphasises the need to make HIV-RNA testing more widely available.