Scaling-Up Highly Active Antiretroviral Therapy (HAART) in Peru: Problems on the Horizon

Echevarría, Juan; Castilla, Diego López de; Seas, Carlos; Verdonck, Kristien; Gotuzzo, Eduardo

doi:10.1097/01.qai.0000242460.35768.0c

Cited by 9 publications

(10 citation statements)

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“…Despite this, there was decreased mortality in later years of HAART initiation at GHESKIO-Haiti, suggesting an improvement in care over time. Structural factors, such as interruptions in drug supply [16] and shortage of staff [17] in Peru and bureaucracy and delays in Chile [15], may have affected program effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Mortality During the First Year of Potent Antiretroviral Therapy in HIV-1-Infected Patients in 7 Sites Throughout Latin America and the Caribbean

Tuboi¹,

Schechter²,

McGowan³

et al. 2009

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Although nearly 2 million people live with HIV in Latin America and the Caribbean, mortality rates after initiation of highly active antiretroviral therapy (HAART) have not been well-described. Methods 5,152 HIV-infected, antiretroviral-naïve adults from clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru starting HAART during 1996–2007 were included. First-year mortality rates and their association with demographics, regimen, baseline CD4, and clinical stage were assessed. Results Overall 1-year mortality rate was 8.3% (95% confidence interval [CI]:7.6–9.1%), although variable across sites: 2.6, 3.7, 6.0, 13.0, 10.8, 3.5, and 9.8% for clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru, respectively. 80% of deaths occurred within the first 6 months. Median baseline CD4 was 107 cells/μL, ranging from 79 (Peru) to 163 (Argentina). Mortality estimates adjusting for CD4 were similar across sites (1.1–2.8% for CD4=200), except for Haiti, 7.5%, and Honduras, 7.0%. Death was associated with lower CD4 (adjusted hazard ratio [HR] for CD4=200 vs CD4=50 was 0.58; 95% CI:0.40–0.85) and clinical AIDS (HR=3.1; 95% CI:2.1–4.5). Conclusions Mortality rates were similar to those reported elsewhere for resource-limited settings. Disease stage at HAART initiation, treatment eligibility criteria, program age, and background mortality rates may explain some variability in prognosis between sites.

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Section: Discussionmentioning

confidence: 99%

Mortality During the First Year of Potent Antiretroviral Therapy in HIV-1-Infected Patients in 7 Sites Throughout Latin America and the Caribbean

Tuboi¹,

Schechter²,

McGowan³

et al. 2009

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…The seroprevalence for MSM is 10-22% [2-4], compared to 0.1-0.4% for the general population [5], and 1% for female sex workers [6]. Antiretroviral therapy, available through the national ART program in Peru since 2004 [1,7], is a key component of improving health outcomes for HIV-positive individuals. To achieve optimal results from ART, high levels of patient adherence to ART are critical [8-10].…”

Section: Introductionmentioning

confidence: 99%

Understanding the facilitators and barriers of antiretroviral adherence in Peru: A qualitative study

et al. 2010

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BackgroundAntiretroviral scale-up is increasing in resource-constrained settings. To date, few studies have explored the barriers and facilitators of adherence to ART in these settings. Facilitators and barriers of antiretroviral adherence in Peru are not completely understood.MethodsAt two clinics that serve a large number of HIV-positive individuals in Lima, Peru, 31 in-depth interviews were carried out in 2006 with adult HIV-positive individuals receiving ART. Purposive sampling was used to recruit the participants. Interviews were transcribed and coded using two Spanish-speaking researchers and a content analysis approach to identify themes in the data.ResultsAmong the participants, 28/31 (90%) were male, 25/31 (81%) were self-identified as mestizo, and 19/31 (61%) had an education above high school. The most frequently discussed barriers to adherence included side effects, simply forgetting, inconvenience, dietary requirements, being away from home, and fear of disclosure/stigma. The most frequently discussed facilitators to adherence included having a fixed routine, understanding the need for compliance, seeing positive results, treatment knowledge, and faith in treatment.ConclusionsOverall, these findings were similar to the facilitators and challenges experienced by individuals on ART in other resource constrained settings. Further treatment support tools and networks should be developed to decrease the challenges of ART adherence for HIV-positive individuals in Lima, Peru.

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“…El peso promedio fue 55,6 ± 10,8Kg, pero 136 (29,9%) sujetos pesaron menos de 50Kg. Las razones para iniciar la TARGA fueron: estadío SIDA 299/453 (66%), asintomáticos con valor de CD4 menor a 200 células/mm 3 o carga viral mayor a 55 000 VIH-1 ARN copias/mL 154/453 (34%). Se contó con al menos un valor basal de CD4 en 415 pacientes (92%) y de carga viral en 298 (66%).…”

Section: Resultados Características Iniciales De La Poblaciónunclassified

“…Results: A total of 453 patients were included in the study: 68% were male; the mean age was 35.7 ±9.5 years and mean body weight was 55.6±10.8 Kg. Mean baseline CD4 cell count was 98 cells/mm 3 and viral load was 278,438 copies/mL. Eighty-four patients discontinued HAART (22 abandoned treatment, 59 died and 3 were transferred to another institution).…”

Section: Discussionmentioning

confidence: 99%

Efecto de la terapia antiretroviral de gran actividad (TARGA) en pacientes enrolados en un hospital público en Lima-Perú.

Zárate¹,

Koster²,

Quilca³

et al. 2012

Rev Med Hered

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RESUMEN.Introducción: En mayo del 2004, el Ministerio de Salud (MINSA) en colaboración con el Fondo Global de lucha contra el SIDA, la tuberculosis y la malaria implementó el programa nacional (PN) para brindar terapia antiretroviral en forma gratuita a todos los pacientes infectados con el VIH con indicación de tratamiento de acuerdo a la guía del PN. Objetivos: Describir las características pre-tratamiento antiretroviral, respuesta a la terapia antiretroviral de gran actividad (TARGA), toxicidad y tasa de mortalidad de la población de pacientes que iniciaron TARGA a través del PN en un hospital general. Material y Métodos: Revisamos las historias clínicas, fichas médicas, resultados de laboratorio y tarjetas de TARGA de todos los pacientes enrolados en el PN en el Hospital Nacional Cayetano Heredia (HNCH) y describimos las características pre-tratamiento antiretroviral, respuesta a la TARGA, toxicidad y tasa de mortalidad. Los pacientes seleccionados para este estudio fueron sujetos infectados con el VIH que: (i) tenían 18 años o más; (ii) iniciaron TARGA en el PN entre mayo 2004 y abril 2006; y (iii) no habían recibido terapia antiretroviral anteriormente (naïve). Se consideró como éxito virológico a la presencia de por lo menos un valor de carga viral indetectable (VIH-1 ARN < 400 copias/mL) entre los 3-6 meses posteriores al inicio de la TARGA. Resultados: Se incluyeron en el estudio a 453 pacientes: 68% fueron varones, la edad promedio fue 35,7 ± 9,5 años y el peso fue 55,6 ± 10,8 Kg. El valor medio de CD4 pre-tratamiento fue 98 células/mm 3 y el de carga viral fue 278 438 VIH-1 ARN copias/mL. Descontinuaron el tratamiento 84 pacientes (22 abandonaron, 59 fallecieron y 3 fueron transferidos a otra institución). Aquellos que continuaron fueron seguidos en promedio 337 días; el 38% (142/369) interrumpió temporalmente la TARGA, principalmente debido a toxicidad medicamentosa (82%). Se obtuvo éxito virológico en 85% de los pacientes. La mortalidad fue 13% y el 74% de las muertes ocurrió antes de los 3 meses de tratamiento. Conclusión: A pesar de una elevada frecuencia de interrupción del tratamiento, nuestros resultados muestran que la respuesta a las medicinas distribuidas por el PN es comparable a la reportada por programas de otros países. Es necesario realizar más estudios que evalúen la respuesta al tratamiento antiretroviral a largo plazo en el Perú. (Rev Med

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Scaling-Up Highly Active Antiretroviral Therapy (HAART) in Peru: Problems on the Horizon

Cited by 9 publications

References 1 publication

Mortality During the First Year of Potent Antiretroviral Therapy in HIV-1-Infected Patients in 7 Sites Throughout Latin America and the Caribbean

Mortality During the First Year of Potent Antiretroviral Therapy in HIV-1-Infected Patients in 7 Sites Throughout Latin America and the Caribbean

Understanding the facilitators and barriers of antiretroviral adherence in Peru: A qualitative study

Efecto de la terapia antiretroviral de gran actividad (TARGA) en pacientes enrolados en un hospital público en Lima-Perú.

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