173 Long-term Follow-up of a Cohort Patients under HAART in Senegal Christian Laurent1, Ndeye Fatou 2, Ngom Gueye2, Ndella Diakhaté2, Adama Ndir3, Mandoumbé Gueye4, Isabelle Laniece1, Mame Awa Faye2, Coumba Touré Kane5, Florian Liégeois1, Roland Landman6, Souleymane Mboup5, Ibrahima Ndoye3, Eric Delaporte1, Papa Salif Sow*2 1Inst de Recherche pour le Dev IRD, UR 36 and Univ of Montpellier, France; 2Fann Univ Hosp, Dakar, Senegal; 3Natl AIDS Prgm, Dakar, Senegal; 4Military Hosp, Dakar, Senegal; 5Le Dantec Univ Hosp, Dakar, Senegal; and 6French Inst of Tropical Med and Epid, Paris, France
Background: To study at long-term the feasibility, effectiveness, adherence, toxicity, and viral resistance of ART in one of the first cohort of patients under HAART in Africa.
Methods: A pilot study started in Dakar in August 1998. Available drugs included NRTI (d4T, ddI, ZDV, 3TC), NNRTI (efavirenz, NVP), and protease inhibitors (IDV, NFV). The patients (pts) attended monthly medical examinations. Plasma HIV-1 RNA and CD4 cell counts were determined at baseline and every 6 months (mos).
Results: Up to February 2001, 150 pts were recruited, most of them being naive of ART (90%). Four (4) pts were infected by HIV-2 and 4 others by HIV-1+2. The median age was 39 yrs (IQR 32-46), and there were 67 women. Eleven (11, 8.4%), 37 (28.2%), and 83 (63.4%) pts were in CDC classes A, B, and C, respectively; 109 (83.2%) had AIDS. The median CD4 cell count was 150/mm3 (IQR 61-236), the median plasmatic viral load 133,916 copies/ml (IQR 29,505-261,070) and the median body mass index (BMI) 19.9 (IQR 18.1-22.7). At baseline, in addition to 2 NRTI, most pts (61.1%) received a PI while 25.2% received a NNRTI. Pts were followed for a median length of 26 mos. After 30 mos of treatment, the median CD4 cell count increased to 437/mm3 (IQR 311-577), the median plasmatic viral load decreased to 75 copies/ml (IQR < 50-2,239), and the BMI increased to 20.9 (IQR 19.2-23.2). Viral load was undetectable (< 50 copies/ml) in 41.9% of pts, and adherence was excellent in 77.8% of them. Fourteen (14) severe adverse effects were reported in 12 pts; 8 of degree 3 (hepatitis (n = 5), hyperbilirubinemia/hives (n = 1)) and 6 of degree 4 (anemia (n = 2), pancytopenia (n = 1)). Thirteen (13) pts' viruses developed a resistance during follow-up: 5 to 3TC, 4 to ZDV, 1 to d4T, 2 to NFV, and 1 to ZDV-3TC-PI.
Conclusions: The long-term follow-up of pts under HAART in Senegal confirms the feasibility of ART in Africa, with clinical and biological results comparable to those seen in western countries despite differences in the HIV-1 subtype distribution and advanced disease stage when the treatment was initiated.