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Preliminary Analysis of the first 306 treatment-naïve persons receiving HAART via the National ARV Program Ndwapi Ndwapi 1, Hermann Bussmann3 , Tendani Gaolathe 1, Andrew Mujugira 1, Geoffrey Tirelo 1, William Wester 3, Ava Avalos 3, Ronald Collman2 , Howard Moffat 1, Peter Trevor 3, Soyeon Kim 3, Chris Vanderwarker 3, Max Essex 3,4 and Richard Marlink3,4 1Infectious Disease Care Clinic; Princess Marina Hospital, Gaborone, Botswana, 2 University of Pennsylvania, Philadelphia, Pennsylvania, USA, 3Botswana-Harvard Partnership for HIV Research and Education, 4Harvard School of Public Health, Department of Immunology and Infectious Disease, Boston, Massachusetts, USA Background: Botswana’s National Antiretroviral Treatment (ART) Program began in January 2002 in Gaborone at Princess Marina Hospital (PMH). Individuals with an AIDS-defining illness and/or a CD4 value of less than 200 cells/mm3 are eligible to receive highly active antiretroviral therapy (HAART). The following data detail the response to treatment of first 306 treatment-naïve persons who were enrolled at the Gaborone site. Methods: Preliminary results come from a retrospective analysis of all HIV-infected, treatment-naive persons who were eligible to begin ARV therapy at the PMH site between January 2002 and June 2003. These results include overall description of immunologic and virologic response to HAART. 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 value was 81 cells/_l and the mean viral load (VL, Roche Amplicor) was 442 000 copies/ml. 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 (9) month on treatment the mean CD4 increase was 166 (204) cells/_l, and 259 (84.5%) of patients had an undetectable VL (<400 copies/ml). Five persons had subsequently a VL load rebound (>20000 copies) and 2 patients never had a VL fall by >1 log. As of February28, 2003, 33 (10.8%) patients who ever started ARV therapy had died and 26 (8.5%) were lost to follow-up. Conclusion: An excellent response to ARV treatment was documented in one of the first and fastest growing national ARV treatment sites in sub-Sahara Africa, a region where HIV-1C is prevalent. Virologic response rates were similar to response to HAART in industrialized nations. CD4 cell count rises steadily through the first 9 months . Excellent medication adherence within the first year of therapy was demonstrated by most participants as evidenced by low failure rate and consistency to outpatient clinic visit schedules. |