Initial response to highly active antiretroviral therapy in HIV-1C-infected adults in a public sector treatment program in Botswana

C. William Wester, Soyeon Kim, Hermann Bussmann, Ava Avalos, Trevor F. Peter, Tendani Gaolathe, Andrew Mujugira, Lesego Busang, Chris Vanderwarker, Peter Cardiello, Onalethata Johnson, Ibou Thior, Patson Mazonde, Howard Moffat, Max Essex, Richard Marlink

Research output: Contribution to journalArticlepeer-review

106 Scopus citations

Abstract

Objective: To describe the response to highly active antiretroviral treatment (HAART) in a public sector pilot antiretroviral (ARV) treatment program in Botswana. Methods: The response to HAART is described in adult HIV-infected ARV-naive patients initiating treatment from April 2001 to January 2002 at Princess Marina Hospital in Gaborone, Botswana. Patients had medical and laboratory evaluations before initiating ARV treatment and were followed longitudinally. For analysis, data were collected from charts and patient management records. Results: One hundred fifty-three ARV-naive patients initiated HAART Most received didanosine plus stavudine (ddl + d4T) with efavirenz or nevirapine. The mean CD4+ cell count increase was 149 cells/mm3 at 24 weeks and 204 cells/mm3 at 48 weeks. The percentage of patients with an HIV-1 RNA level ≤400 copies/mL was 87.0% at 24 weeks and 78.8% at 48 weeks. The Kaplan-Meier 1-year survival estimate was 84.7% (79.0%, 90.8%), with a 3.2-fold increased risk (P = 0.004) of mortality among patients with a CD4+ cell count <50 cells/mm3. The 1-year Kaplan-Meier estimate of toxicity-related drug switches was 32.2% (20.3%, 40.4%). The most common toxicity was peripheral neuropathy, occurring more frequently in patients with a preexisting diagnosis of peripheral neuropathy and among those placed on ddl + d4T-containing regimens. Conclusions: An excellent response to HAART was observed among HIV-1C-infected patients, paralleling those seen elsewhere. Despite excellent responses, high rates of toxicity were observed for ddI + d4T-containing regimens.

Original languageEnglish (US)
Pages (from-to)336-343
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume40
Issue number3
DOIs
StatePublished - Nov 1 2005
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Infectious Diseases
  • Pharmacology (medical)

Keywords

  • Africa
  • Antiretroviral treatment
  • Botswana
  • HIV/AIDS
  • Highly active antiretroviral therapy
  • Public

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