Characterization of virologic failure after an initially successful 48-week course of antiretroviral therapy in HIV/AIDS outpatients treated in Santos, Brazil

Abstract

We characterized the virologic failure after an initially successful 48-week course of antiretroviral therapy among HIV/AIDS patients in a retrospective cohort study involving patients from Santos, Brazil. Patients with plasma HIV RNA below 500 copies/mL for 48 weeks were included. Variables analyzed included gender, age, level of education, marital status, mode of HIV acquisition, viral load, and CD4 cell count upon admission. There were 4,909 patients registered with the clinic, of which 669 patients met all the inclusion criteria (41.6% female and 58.4% male). Only 27.5% of the patients maintained undetectable viral loads during up to one year of follow-up. After 48 weeks, virologic failure occurred earlier in females and in patients first treated with an antiretroviral regimen other than highly active antiretroviral therapy. Patients who were married or had a steady partner experienced virologic failure later than did those who were separated or widowed. The percentage of public health clinic patients who maintain undetectable viral loads for a period of over a year is much lower than that observed among patients enrolled in clinical trials. Females, individuals in unstable relationships, single individuals and widowed individuals should be given special attention in order to improve durability of viral suppression.

EVOLUTION OF PATIENTS WITH AIDS AFTER cART: CLINICAL AND LABORATORY EVOLUTION OF PATIENTS WITH AIDS AFTER 48 WEEKS OF ANTIRETROVIRAL TREATMENT

“…However, these are better data than those of PINTO NETO et al 29 in 1998 and 1999 in Vitoria (ES), and CASEIRO et al 3 between 1997 and 2003 in Santos (SP) who found 50.0% and 44.0% respectively. The percentages found in the present study are also higher than those registered in the systematic review of BARTLETT et al 1 in the United States of America in 2001, in which the schemes containing PI produced an undetectable viral load in 46.0% of cases versus 51% under NNRTI.…”

“…The medians in G1 and G2 were 723 cells/mm 3 Tables or Figures). The analysis of plasma VL determinations is also shown in these Figures.…”

“…After 12 weeks of treatment, G1 and G2 presented an equal mean increase of 141 cells and 144 cells. FERRADINI et al 8 in Cambodia, Asia, showed that a strong immune reconstitution was observed after 24 months (gain of 258 cells/mm 3 [IQR: 136-425]) of follow-up on second-line cART regimens. In 2010 in Brazil, a study by SANTOS et al 33 that compared these cell counts before and after 36 months of treatment regardless of the ARV scheme used, demonstrated an average increase of 225 T CD4+ cells.…”

“…plasma quantification of HIV-1 RNA were accomplished by the flow cytometry technique and by the branched-DNA method respectively, during the routine medical visits of patients at the Botucatu Hemocenter, UNESP. The results were expressed as absolute numbers per cubic millimeter of blood (cells/mm 3 ) and as absolute numbers of virus copies RNA per milliliter of plasma and base-10 logarithm (log 10).…”

“…The risk of progression of HIV infection to the development of AIDS or to death is initially related to an elevated HIV viral load (VL), and subsequently to a low count of CD4 + T lymphocytes 3,4 . These markers are considered the principal to evaluate the clinical status of the patient and to monitor and indicate the start of cART 19 , following recommendations specific to each country, which have been changed over time 21,22 .…”