Immunovirological outcomes and resistance patterns at 4 years of antiretroviral therapy use in HIV‐infected patients in Cambodia

Abstract

Summaryobjectives To report immunovirological outcomes and resistance patterns in adults treated with triple combination antiretroviral therapy (cART) for 4 years in an HIV programme of Phnom Penh, Cambodia.methods It is a longitudinal study and cross-sectional evaluation of adults receiving cART for 4 years. CD4 cell counts and HIV-1 RNA were quantified, and resistance patterns were determined. Drug-related toxicity was assessed by clinicians and through laboratory testing.results After 4 years of cART start, the cumulative probability of retention in care was 0.80 and survival among patients not lost to follow-up was 0.85. A total of 349 patients (98% of eligible) participated in the cross-sectional evaluation. Ninety per cent were receiving first-line therapy, 29% stavudine-and 58% zidovudine-containing regimens (compared with 94% and 3% at cART initiation). Ninety-three per cent of patients were clinically asymptomatic, and severe lipodystrophy and dyslipidemia were diagnosed in 7.2% and 4.0%, respectively. Good treatment adherence was reported by 83% of patients. Median CD4 T-cell count was 410 cells ⁄ ll , and 90% of patients had >200 cells ⁄ ll. Only 15 (4%) patients had detectable HIV viral load (eight had <200 CD4 cells ⁄ ll), five had thymidine analogue mutations, and nine were resistant to two drug classes. In an intention-to-treat analysis, 26.1% (95% CI 22.0-30.5) of patients had failed first-line therapy.conclusions In this Cambodian cohort of adults who started cART at an advanced stage of HIV disease, we observed good clinical and immunovirological outcomes and self-reported treatment adherence at 4 years of therapy.

Virological Failure and HIV-1 Drug Resistance Mutations among Naive and Antiretroviral Pre-Treated Patients Entering the ESTHER Program of Calmette Hospital in Cambodia

“…This result is consistent with previous reports of studies conducted one to four years after the onset of first-line ARV regimen in Cambodia [27]–[31]. The VF rate observed after 4 year of ART was similar (4%) in another Phnom Penh hospital [30]. Interestingly, the VF rate reported herein is lower than that reported in sub-Saharan Africa patients where up to 24% of VF is obtained within 12 months of initiation of first-line ART [32].…”

“…All naive patients harbored viruses that were resistant to NVP/EFV with a majority of them showing the K103N/S mutation. The rates of 181C/I, K103N/S G190A and M184L/V mutations were also higher than in another recent study in Cambodia among patients having a median duration of 12 months up to 4 years on antiretroviral therapy [6], [7], [30]. The level of transmitted drug resistance (TDR) in naive patients needs to be assessed and could explain the high level of resistance mutations for this population potentially more recently infected than pre-treated patients.…”

Impact of peer support on virologic failure in HIV-infected patients on antiretroviral therapy - a cluster randomized controlled trial in Vietnam

“…A recent study in Vietnam conducted among 4531 adults and 313 children showed that 81.2 and 84.4%, respectively, were still on ART after 12 months [49]. This result was similar with the retention rate in Thailand (80.8% after 5 years) [45], Cambodia (80% after 4 years) [43] and higher compared to studies in sub-Saharan Africa with 24 months of follow-up: Uganda (72%) [36] and Malawi (66%) [37]. Other studies also showed that engagement of HIV care is associated with improved clinical, virologic and immunologic parameters and survival outcomes [50, 51].…”

Women experience a better long-term immune recovery and a better survival on HAART in Lao People’s Democratic Republic

“…Several studies on cohorts of HIV-infected patients receiving HAART in Thailand and Cambodia have been published but to date, there is no equivalent publication on the outcomes of patients on-HAART in Lao PDR [15-20]. To fill this gap, we conducted a retrospective analysis on a database made available to us by the Ministry of health/Center for HIV and STI and MSF in order to report the first results on patients receiving HAART at Savannakhet Provincial Hospital, located on the Thai-Lao border, between April 2003 and June 2009.…”