Antiretroviral therapy in resource-limited settings 1996 to 2006

Patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America

Olivia Keiser, Kathryn Anastos, Mauro Schechter, Eric Balestre, Landon Myer, Andrew Boulle, David Bangsberg, Hapsatou Touré, Paula Braitstein, Eduardo Sprinz, Denis Nash, Mina Hosseinipour, François Dabis, Margaret May, Martin W G Brinkhof, Matthias Egger

Research output: Contribution to journalArticle

148 Citations (Scopus)

Abstract

Objectives: To describe temporal trends in baseline clinical characteristics, initial treatment regimens and monitoring of patients starting antiretroviral therapy (ART) in resource-limited settings. Methods: We analysed data from 17 ART programmes in 12 countries in sub-Saharan Africa, South America and Asia. Patients aged 16 years or older with documented date of start of highly active ART (HAART) were included. Data were analysed by calculating medians, interquartile ranges (IQR) and percentages by regions and time periods. Not all centres provided data for 2006 and 2005 and 2006 were therefore combined. Results: A total of 36 715 patients who started ART 1996-2006 were included in the analysis. Patient numbers increased substantially in sub-Saharan Africa and Asia, and the number of initial regimens declined, to four and five, respectively, in 2005-2006. In South America 20 regimes were used in 2005-2006. A combination of 3TC/D4T/NVP was used for 56% of African patients and 42% of Asian patients; AZT/3TC/EFV was used in 33% of patients in South America. The median baseline CD4 count increased in recent years, to 122 cells/μl (IQR 53-194) in 2005-2006 in Africa, 134 cells/μl (IQR 72-191) in Asia, and 197 cells/μl (IQR 61-277) in South America, but 77%, 78% and 51%, respectively, started with <200 cells/μl in 2005-2006. In all regions baseline CD4 cell counts were higher in women than men: differences were 22cells/μl in Africa, 65 cells/μl in Asia and 10 cells/μl in South America. In 2005-2006 a viral load at 6 months was available in 21% of patients Africa, 8% of Asian patients and 73% of patients in South America. Corresponding figures for 6-month CD4 cell counts were 74%, 77% and 81%. Conclusions: The public health approach to providing ART proposed by the World Health Organization has been implemented in sub-Saharan Africa and Asia. Although CD4 cell counts at the start of ART have increased in recent years, most patients continue to start with counts well below the recommended threshold. Particular attention should be paid to more timely initiation of ART in HIV-infected men.

Original languageEnglish (US)
Pages (from-to)870-879
Number of pages10
JournalTropical Medicine and International Health
Volume13
Issue number7
DOIs
StatePublished - Jul 2008
Externally publishedYes

Fingerprint

Latin America
Africa South of the Sahara
South America
CD4 Lymphocyte Count
Therapeutics
Lamivudine
Stavudine
Highly Active Antiretroviral Therapy
Physiologic Monitoring
Viral Load
Public Health
HIV

Keywords

  • Antiretroviral therapy
  • Asia
  • Gender identity
  • Highly active
  • HIV/AIDS
  • Latin America
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Parasitology
  • Immunology

Cite this

Antiretroviral therapy in resource-limited settings 1996 to 2006 : Patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America. / Keiser, Olivia; Anastos, Kathryn; Schechter, Mauro; Balestre, Eric; Myer, Landon; Boulle, Andrew; Bangsberg, David; Touré, Hapsatou; Braitstein, Paula; Sprinz, Eduardo; Nash, Denis; Hosseinipour, Mina; Dabis, François; May, Margaret; Brinkhof, Martin W G; Egger, Matthias.

In: Tropical Medicine and International Health, Vol. 13, No. 7, 07.2008, p. 870-879.

Research output: Contribution to journalArticle

Keiser, O, Anastos, K, Schechter, M, Balestre, E, Myer, L, Boulle, A, Bangsberg, D, Touré, H, Braitstein, P, Sprinz, E, Nash, D, Hosseinipour, M, Dabis, F, May, M, Brinkhof, MWG & Egger, M 2008, 'Antiretroviral therapy in resource-limited settings 1996 to 2006: Patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America', Tropical Medicine and International Health, vol. 13, no. 7, pp. 870-879. https://doi.org/10.1111/j.1365-3156.2008.02078.x
Keiser, Olivia ; Anastos, Kathryn ; Schechter, Mauro ; Balestre, Eric ; Myer, Landon ; Boulle, Andrew ; Bangsberg, David ; Touré, Hapsatou ; Braitstein, Paula ; Sprinz, Eduardo ; Nash, Denis ; Hosseinipour, Mina ; Dabis, François ; May, Margaret ; Brinkhof, Martin W G ; Egger, Matthias. / Antiretroviral therapy in resource-limited settings 1996 to 2006 : Patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America. In: Tropical Medicine and International Health. 2008 ; Vol. 13, No. 7. pp. 870-879.
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abstract = "Objectives: To describe temporal trends in baseline clinical characteristics, initial treatment regimens and monitoring of patients starting antiretroviral therapy (ART) in resource-limited settings. Methods: We analysed data from 17 ART programmes in 12 countries in sub-Saharan Africa, South America and Asia. Patients aged 16 years or older with documented date of start of highly active ART (HAART) were included. Data were analysed by calculating medians, interquartile ranges (IQR) and percentages by regions and time periods. Not all centres provided data for 2006 and 2005 and 2006 were therefore combined. Results: A total of 36 715 patients who started ART 1996-2006 were included in the analysis. Patient numbers increased substantially in sub-Saharan Africa and Asia, and the number of initial regimens declined, to four and five, respectively, in 2005-2006. In South America 20 regimes were used in 2005-2006. A combination of 3TC/D4T/NVP was used for 56{\%} of African patients and 42{\%} of Asian patients; AZT/3TC/EFV was used in 33{\%} of patients in South America. The median baseline CD4 count increased in recent years, to 122 cells/μl (IQR 53-194) in 2005-2006 in Africa, 134 cells/μl (IQR 72-191) in Asia, and 197 cells/μl (IQR 61-277) in South America, but 77{\%}, 78{\%} and 51{\%}, respectively, started with <200 cells/μl in 2005-2006. In all regions baseline CD4 cell counts were higher in women than men: differences were 22cells/μl in Africa, 65 cells/μl in Asia and 10 cells/μl in South America. In 2005-2006 a viral load at 6 months was available in 21{\%} of patients Africa, 8{\%} of Asian patients and 73{\%} of patients in South America. Corresponding figures for 6-month CD4 cell counts were 74{\%}, 77{\%} and 81{\%}. Conclusions: The public health approach to providing ART proposed by the World Health Organization has been implemented in sub-Saharan Africa and Asia. Although CD4 cell counts at the start of ART have increased in recent years, most patients continue to start with counts well below the recommended threshold. Particular attention should be paid to more timely initiation of ART in HIV-infected men.",
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T2 - Patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America

AU - Keiser, Olivia

AU - Anastos, Kathryn

AU - Schechter, Mauro

AU - Balestre, Eric

AU - Myer, Landon

AU - Boulle, Andrew

AU - Bangsberg, David

AU - Touré, Hapsatou

AU - Braitstein, Paula

AU - Sprinz, Eduardo

AU - Nash, Denis

AU - Hosseinipour, Mina

AU - Dabis, François

AU - May, Margaret

AU - Brinkhof, Martin W G

AU - Egger, Matthias

PY - 2008/7

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N2 - Objectives: To describe temporal trends in baseline clinical characteristics, initial treatment regimens and monitoring of patients starting antiretroviral therapy (ART) in resource-limited settings. Methods: We analysed data from 17 ART programmes in 12 countries in sub-Saharan Africa, South America and Asia. Patients aged 16 years or older with documented date of start of highly active ART (HAART) were included. Data were analysed by calculating medians, interquartile ranges (IQR) and percentages by regions and time periods. Not all centres provided data for 2006 and 2005 and 2006 were therefore combined. Results: A total of 36 715 patients who started ART 1996-2006 were included in the analysis. Patient numbers increased substantially in sub-Saharan Africa and Asia, and the number of initial regimens declined, to four and five, respectively, in 2005-2006. In South America 20 regimes were used in 2005-2006. A combination of 3TC/D4T/NVP was used for 56% of African patients and 42% of Asian patients; AZT/3TC/EFV was used in 33% of patients in South America. The median baseline CD4 count increased in recent years, to 122 cells/μl (IQR 53-194) in 2005-2006 in Africa, 134 cells/μl (IQR 72-191) in Asia, and 197 cells/μl (IQR 61-277) in South America, but 77%, 78% and 51%, respectively, started with <200 cells/μl in 2005-2006. In all regions baseline CD4 cell counts were higher in women than men: differences were 22cells/μl in Africa, 65 cells/μl in Asia and 10 cells/μl in South America. In 2005-2006 a viral load at 6 months was available in 21% of patients Africa, 8% of Asian patients and 73% of patients in South America. Corresponding figures for 6-month CD4 cell counts were 74%, 77% and 81%. Conclusions: The public health approach to providing ART proposed by the World Health Organization has been implemented in sub-Saharan Africa and Asia. Although CD4 cell counts at the start of ART have increased in recent years, most patients continue to start with counts well below the recommended threshold. Particular attention should be paid to more timely initiation of ART in HIV-infected men.

AB - Objectives: To describe temporal trends in baseline clinical characteristics, initial treatment regimens and monitoring of patients starting antiretroviral therapy (ART) in resource-limited settings. Methods: We analysed data from 17 ART programmes in 12 countries in sub-Saharan Africa, South America and Asia. Patients aged 16 years or older with documented date of start of highly active ART (HAART) were included. Data were analysed by calculating medians, interquartile ranges (IQR) and percentages by regions and time periods. Not all centres provided data for 2006 and 2005 and 2006 were therefore combined. Results: A total of 36 715 patients who started ART 1996-2006 were included in the analysis. Patient numbers increased substantially in sub-Saharan Africa and Asia, and the number of initial regimens declined, to four and five, respectively, in 2005-2006. In South America 20 regimes were used in 2005-2006. A combination of 3TC/D4T/NVP was used for 56% of African patients and 42% of Asian patients; AZT/3TC/EFV was used in 33% of patients in South America. The median baseline CD4 count increased in recent years, to 122 cells/μl (IQR 53-194) in 2005-2006 in Africa, 134 cells/μl (IQR 72-191) in Asia, and 197 cells/μl (IQR 61-277) in South America, but 77%, 78% and 51%, respectively, started with <200 cells/μl in 2005-2006. In all regions baseline CD4 cell counts were higher in women than men: differences were 22cells/μl in Africa, 65 cells/μl in Asia and 10 cells/μl in South America. In 2005-2006 a viral load at 6 months was available in 21% of patients Africa, 8% of Asian patients and 73% of patients in South America. Corresponding figures for 6-month CD4 cell counts were 74%, 77% and 81%. Conclusions: The public health approach to providing ART proposed by the World Health Organization has been implemented in sub-Saharan Africa and Asia. Although CD4 cell counts at the start of ART have increased in recent years, most patients continue to start with counts well below the recommended threshold. Particular attention should be paid to more timely initiation of ART in HIV-infected men.

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KW - Asia

KW - Gender identity

KW - Highly active

KW - HIV/AIDS

KW - Latin America

KW - Sub-Saharan Africa

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