Treatment outcome of HAART-treated patients in a resource-limited setting: The Belgrade Cohort Study

Abstract

Introduction: We evaluated the effects of highly-active-antiretroviral-therapy (HAART) in a resource-limited settings. Methods: A cross-sectional study was performed in patients who had initiated HAART at the HIV/AIDS-Center, Belgrade, Serbia. Treatment response was considered favorable in case of the achievement of undetectable HIVRNA plasma-viral-load (pVL lt 50 copies/mu L), and with the CD4+ T-cell counts increased above 350 cells/mu L. The treatment failure was defined as pVL over 1.7 log(10) copies/mL, regardless of immunological improvement. Results: Eight hundred and forty HIV infected patients were followed-up for 8.2 +/- 3.4 years. Out of 697 patients available for follow-up, 113 (16.2%) patients died, 44 (6.3%) experienced treatment failure, while 540 (77.5%) had sustained undetectable viremia. In 419 (60.1%) favorable treatment response was achieved, while the dissociation between immunological and virological responses to HAART occurred in 121 (14.4%). A baseline CD4+ T-cell counts above 200 cells/mL was the single independent predictor of a favorable treatment response (HR = 2, 95%CI = 1.69-2.61, P = 0.001), while pre-treatment with ART, HCV co-infection and AIDS at the time of treatment initiation, were all factors preventing a favorable response (HR = 0.27, 95% CI = 0.19-0.36, P = 0.001; HR = 0.75, 95% CI = 0.56-0.95, P = 0.02; HR = 0.73, 95% CI = 0.17-0.95, P = 0.018, respectively). A sustained viral suppression was an independent predictor of survival (HR = 0.2, 95% CI 0.07-0.61, P = 0.004). HAART treated HIV-infected patients who reach and maintain undetectable viremia, have an 80% probability of a 14-years survival (P = 0.08, log-rank). Conclusion: If patient with advanced HIV-related immunodeficiency reach and maintain optimal viral suppression during HAART, regardless of the level of immune recovery, and if they continue to maintain this, their prognosis may be fairly good even in the resource-limited settings.