AEGiS-13IAC: The clinical effectiveness of antiretroviral multitherapy in a limited resource context: the example of the Senegalese arv access initiative.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

The clinical effectiveness of antiretroviral multitherapy in a limited resource context: the example of the Senegalese arv access initiative.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB297)

Sow PS, Laurent C, Gueye PM, Faye-Niang MA, Ciss M, Mboup S, Badiane S, Delaporte E, Ndoye I
P.S. Sow, Clinique des Maladies infectieuses - Chu de Fann, BP 5035, Dakar Fann, Senegal, Tel.: +221 825 25 47, Fax: +221 825 36 95, E-mail: salifsow@telecomplus.sn

OBJECTIVE: To describe the clinical effectivness of the antiretroviral therapy (ARV) in a limited resources context .

METHODOLOGY: before instituting antiretroviral therapy in Senegal, the preconditions were defined by a medical technical committee. A medical assessment is conducted for each patient before ARV therapy initiation.

RESULTS: From August 1998 to December 1999, 68 patients have been recruited for antiretroviral treatment; intended treatment was a tritherapy for 60 of them (88.2%) and a bitherapy for the 8 others (11.8%). The patients mean age was 38.5 years. The sex ratio was 1. The patients' clinical stages (CDC) were: category C for 73.5% (n = 50), category B for 22.1% (n = 15) and category A for 4.4% (n = 3). At the time of inclusion, the median CD4 was 144/mm³ and the median plasmatic viral load was 81,650 copies/ml. The main therapeutic regimen for tritherapy was d4T+ddI+Indinavir (44/60) and AZT+3TC+Indinavir (10/60). At month 1 (M1), 71.4% of patients achieved undetectable viral loads (> 500 copies/ml). At the sixth month of treatment, a favorable clinical evolution was noted with a Body Mass Index increasing from 20,10 at M0 to 21,1 at M6 (p > 0.001) and an improvement of the Karnofsky index. The median CD4 lymphocyte count was 221,5/mm³ after 6 months of treatment. During follow up, 2 patients withdrew, 10 patients died. The pathological events noted among these patients are dominated by polynevrites and candidiasis. Only one case of renal lithiasis, due to Indinavir, and one case of buffalo-neck lipodystrophy was observed. During follow-up, 57 of 66 patients (86,4%) have reported having taken at least 80% of their drugs.

CONCLUSION: This intermediate analysis showed clinical, immunological, and virologic effectiveness for antiretroviral therapy in Senegal. Patient adherence to protocols was the result of close communication between doctors, pharmacists, social workers and patients.

Keywords: AEGIS, Viral Load, CD4 Lymphocyte Count, Indinavir, Stavudine, Didanosine, Zidovudine, Lamivudine, Senegal, Human
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TuOrB297