International AIDS Society location:Toronto, Canada date:2006
Data on overall outcomes of antiretroviral programs in resource-poor settings are scarce.
We entered characteristics, opportunistic infections, antiretrovirals and test results for all patients in Sihanouk Hospital Center of HOPE in Phnom Penh, Cambodia in an Access database. We report on all patients started on HAART between 1-1-2003 and 15-1-2005.
In this period 345 patients started HAART: 172 (49.9%) men and 173 (50.1%) women (15 pregnant). The average age was 34.5 years. Median follow-up before HAART was 291 days. At start 6.4% were antiretroviral experienced, 64.3% had WHO stage 4 and 56.8% had nadir CD4 below 50/mm3. 85.2% were on PCP prophylaxis, 70.1% on fungal prophylaxis.
78.3% started with NVP/d4T/3TC . 11.9% used a combination including efavirenz and 0.3% used a combination with a boosted protease inhibitor (PI).
1 year after start 303 (87.8%) were in active follow-up, 8.4% had died (median duration to death 61 days) and 3.8% were lost. 12.2% had developed mild and 3.8% severe neuropathy, 10.1% had developed skin rash, 8.7% hepatitis and 7.5% central nervous system side-effects. 10 (2.9%) had developed immunological failure (WHO 2003 criteria). 95 patients (28%) switched minimum one drug. Main reasons were for nevirapine: skin rash (15), interaction medication (25), TB-infection (11), for stavudine: neuropathy (15), lipodystrophy (8), for zidovudine: anemia (12). Mean weight gain was 3.9kg. Mean CD4 gain was 143/mm3.
297 were on HAART 12 months after start. 195 (57% of patients started) were on NVP/d4T/3TC . 70 (20.3%) used a combination including efavirenz and 3 including a boosted PI.
Good results can be obtained with HAART in resource-poor settings despite advanced HIV-infection, After 1 year 12% of patients died (mainly early after start) or were lost to the program. Side-effects require drug switches for 25% of patients. On treatment, immunological results are good.