[1216] RESPONSE TO THE BOTSWANA NATIONAL ANTIRETROVIRAL THERAPY PROGRAM-PRELIMINARY ANALYSIS OF THE FIRST 306 TREATMENT-NAÏVE ADULTS RECEIVING HAART VIA THE NATIONAL ARV PROGRAM

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] RESPONSE TO THE BOTSWANA NATIONAL ANTIRETROVIRAL THERAPY PROGRAM-PRELIMINARY ANALYSIS OF THE FIRST 306 TREATMENT-NAÏVE ADULTS RECEIVING HAART VIA THE NATIONAL ARV PROGRAM

[AUTHOR(S):] N Ndwapi¹, H Bussmann³, T Gaolathe¹, A Mujugira¹, G Tirelo¹, W Wester³, A Avalos³, R Collman², H Moffat¹, T Peter³, C Vanderwalker³, I Thior³, M Essex^3,4 and R Marlink^3,4
¹Infectious Disease Care Clinic; Princess Marina Hospital, Gaborone, Botswana; ²University of Pennsylvania, USA; ³Botswana-Harvard Partnership for HIV Research and Education; ⁴Harvard School of Public Health, Department of Immunology and Infectious Disease, Boston, MA, USA

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 1216
Antiviral Therapy 2003; 8(Suppl. 1):S528-S529

[ABSTRACT:] Background: Botswana – a country with one of the highest documented HIV prevalence in the world – began its national ARV treatment (ART) program at the Princess Marina Hospital (PMH) in the city of Gaborone in January 2002. All adult citizens with positive HIV status are offered an initial CD4 cell measurement and those with an AIDS-defining illness and/or with a CD4 value of less than 200 cells/mm³ are eligible to receive free PI-sparing HAART. We present here the response to treatment of the first 306 treatment-naïve patients.

Methods: A retrospective analysis was conducted immunologic and virologic response to HAART of all HIV-infected, treatment-naïve patients who registered at the national adult ART site at PMH from January 21, 2002 through June 10, 2003 and who were initiated on ARV therapy.

Results: Baseline characteristics: Antiretroviral therapy was initiated in 306 HIV-infected treatment-naïve adults (57% female and 43% male). At treatment initiation, the mean CD4 cell count was 81 cells/ml and the mean viral load (VL; Roche Amplicor, Version1.5) was 442,000 copies/ml (5.65 log). 288 persons (94.1%) received CBV and either NVP (47.5%) or EFV (52.4%). Response data: The median time of follow-up was 283 days. After 6 and 9 months on treatment the mean CD4 increase was 166 and 204 cells/ml, respectively. The VL was undetectable (<400 copies/ml) in 259 (84.5%) patients at month 6. Five patients had a VL rebound (>20,000 copies) and two patients never had a ≥1 log fall in VL. As of February 28, 2003, 33 (10.8%) patients who started ARV therapy had died and 26 (8.5%) were lost to follow-up.

Conclusions: An excellent response to ARV treatment was documented in one of the first and fastest growing national ARV treatment sites in sub- Saharan Africa, a region where HIV-1C is prevalent. Virologic response rates were similar to response to HAART in industrialized nations. CD4 cell count rose steadily through the first 9 months. Excellent medication adherence within the first year of therapy was demonstrated by most patients as evidenced by low failure rate and high compliance to outpatient clinic visit schedules.

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