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A decade of HAART in Latin America: Long term outcomes among the first wave of HIV patients to receive combination therapy

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dc.contributor.author Wolff, Marcelo J.
dc.contributor.author Giganti, Mark J.
dc.contributor.author Cortes, Claudia P.
dc.contributor.author Cahn, Pedro
dc.contributor.author Grinsztejn, Beatriz
dc.contributor.author Pape, Jean W.
dc.contributor.author Padgett, Denis
dc.contributor.author Sierra-Madero, Juan
dc.contributor.author Gotuzzo Herencia, José Eduardo
dc.contributor.author Duda, Stephany N.
dc.contributor.author McGowan, Catherine C.
dc.contributor.author Shepherd, Bryan E.
dc.contributor.author CCASAnet
dc.date.accessioned 2019-01-25T15:02:13Z
dc.date.available 2019-01-25T15:02:13Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4584
dc.description.abstract BACKGROUND: In Latin America, the first wave of HIV-infected patients initiated highly active antiretroviral therapy (HAART) 10 or more years ago. Characterizing their treatment experience and corresponding outcomes across a decade of HAART may yield insights relevant to the ongoing care of such patients and those initiating HAART more recently in similar clinical settings. METHODS: This retrospective study included adults initiating HAART before 2004 at 8 sites in Argentina, Brazil, Chile, Haiti, Honduras, and Mexico. Patient status (in care, dead, or lost to follow-up [LTFU]) was assessed at 6-month intervals for 10 years, along with CD4 count and HIV-1 viral load (VL) for patients in care. RESULTS: 4,975 patients (66% male) started HAART prior to 2004; 45% were not antiretroviral-naïve. At 1, 5, and 10 years, rates of mortality were 4.2%, 9.0%, and 13.6% respectively. LTFU rates for the same periods were 2.4%, 10.9%, and 24.2%. Among patients remaining in care at 10 years, 84.4% were estimated to have VL≤400 copies/mL (Haiti excluded) and median baseline CD4 increased from 158 to 525 cells/mm3. Only 11.4% of all patients remained on their first regimen, 12.6% were on their second, 11.5% were on their third, and 23.0% were on their fourth or subsequent regimen. Outcomes were generally better for patients who were not antiretroviral-naïve, except for viral suppression. Heterogeneity among sites was substantial. CONCLUSIONS: Despite advanced disease and predominant use of older antiretrovirals, a large percentage of early HAART initiators in this Latin American cohort were alive and in care with sustained virologic suppression and progressive immune recovery after 10 years. en_US
dc.language.iso eng
dc.publisher Public Library of Science
dc.relation.ispartofseries PLoS ONE
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Antiretroviral Therapy, Highly Active/trends en_US
dc.subject Adult en_US
dc.subject CD4 Lymphocyte Count en_US
dc.subject Cohort Studies en_US
dc.subject Female en_US
dc.subject HIV Infections/drug therapy/immunology/mortality en_US
dc.subject Humans en_US
dc.subject Latin America/epidemiology en_US
dc.subject Male en_US
dc.subject Retrospective Studies en_US
dc.subject Time Factors en_US
dc.subject Treatment Outcome en_US
dc.subject Viral Load en_US
dc.title A decade of HAART in Latin America: Long term outcomes among the first wave of HIV patients to receive combination therapy en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pone.0179769
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.02
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.01.05
dc.relation.issn 1932-6203


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