Discordant responses to potent antiretroviral treatment in previously naive HIV-1-infected adults initiating treatment in resource-constrained countries: the antiretroviral therapy in low-income countries (ART-LINC) collaboration
Tuboi, S.H.; Brinkhof, M.W.G.; Egger, M.; Stone, R.A.; Braitstein, P.; Nash, D.; Sprinz, E.; Dabis, Fçois.; Harrison, L.H.; Schechter, M.
Journal of Acquired Immune Deficiency Syndromes 45(1): 52-59
2007
ISSN/ISBN: 1525-4135 PMID: 17460471 DOI: 10.1097/qai.0b013e318042e1c3Document Number: 252253
Objectives: To assess the frequency of and risk factors for discordant responses at 6 months on highly active antiretroviral therapy (HAART) in previously treatment-naive HIV patients from resource-limited countries.Methods: The Antiretroviral Therapy in Low-Income Countries Collaboration is a network of clinics providing care and treatment to HIV-infected patients in Africa, Latin America, and Asia. Patients who initiated therapy between 1996 and 2004, were aged 16 years or older, and had a baseline CD4 cell count were included in this analysis. Responses were defined based on plasma viral load (PVL) and CD4 cell count at 6 months as complete virologic and immunologic (VR+IR+), virologic only (VR+IR-), immunologic only (VR-IR+), and nonresponse (VR-IR-). Multinomial logistic regression was used to assess the association between therapy responses and clinical and demographic variables.Results: Of the 3 111 patients eligible for analysis, 1914 had available information at 6 months of therapy: 1074 (56.1%) were VR+IR+, 364 (19.0%) were VR+IR-, 283 (14.8%) were (VR-IR+), and 193 (10.1%) were VR-IR-. Compared with complete responders, virologic-only responders were older, had a higher baseline CD4 cell count, had a lower baseline PVL, and were more likely to have received a nonstandard HAART regimen; immunologic-only responders were younger, had a lower baseline CD4 cell count, had a higher baseline PVL, and were more likely to have received a protease inhibitor-based regimen.Conclusions: The frequency of and risk factors for discordant responses were comparable to those observed in developed countries. Longer follow-up is needed to assess the long-term impact of discordant responses on mortality in these resource-limited settings.