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Session 28 Oral Abstracts and Mini-Lectures
Global AIDS: Epidemiology, Virology, and Clinical Aspects
Wednesday, 10 am - 12:30 pm
Presentation Time: 12:00 pm
Room 2011


148
One Year of HAART in Mozambique: Survival, Virological, and Immunological Results of DREAM Project in Adults and Children
L Palombi*1, P Narciso2, C F Perno1,3, S Mancinelli1, G Guidotti1,4, S Ceffa3,4, F Erba1, G Liotta1, P Germano1,3, A Barreto5, L Emberti Gialloreti3,5, S Vella6,7, and M C Marazzi6,11
1Univ. of Tor Vergata, Rome, Italy; 2Natl. Inst. of Infectious Disease "L.Spallanzani", Rome, Italy; 3Community of Sant'Egidio, Rome Italy; 4Natl. Inst. of Hlth., Rome, Italy; 5Ministry of Hlth., Maputo, Mozambique; 6LUMSA, Rome, Italy; and 7Inst. Superiore di Sanita, Rome, Italy

Background:  Since February 2002 the DREAM program, run in Mozambique by the Community of Sant’Egidio in the frame of public health sector, provided HIV+ patients free-of-charge both HAART and immune-virological monitoring.

Methods:  Until August 2003, 802 HIV+ adults (510 female) and 215 children were included in the community and home-care program at Machava centre (Maputo province):  68.2% adults had CD4-lymphocytes <200/mm3; >1/3 was 3-4 WHO clinical stage. In children, mean CD4 cells percentage was 17.4±10.7.

Results:  Of the total, >50% adults and ~1/3 children (75/215) met criteria to start ARV treatment (generic AZT/d4T + 3TC + nevirapine was given to all of them). Median follow-up was 290 days for treated adults (longer than that of untreated patients‑140 days), and 92 days for children. Lost-to-follow-up rate was 9.3% in adults (higher in untreated group, 12.7% vs 7.2%, p = 0.006), and 3.3% in children. Among adults, rate of patients with <200 CD4/mL after 1 year of treatment decreased from 68.2% to 22.5%; ~75% reached and maintained for 1 year <50 copies HIV-RNA/mL. Viral suppression and immune reconstitution was relevant also among treated children, with median values respectively of -5,2 log HIV/RNA (IQ:  4.3 to 5.6log) and +10.1% CD4 (IQ:  3.8 to 19.1). Death rate was 12.5% and 11.2% in adult and children respectively. Among adults, multivariate Cox model shows the independent role as predictor of longer survival of hemoglobin, CD4-count, viral load and HAART, with risk of 2.34, 1.41, 1.74, and 2.98 respectively (p ≤0.001 each). Among children results were similar, with the underweight as additional risk factor. 

Conclusions:  One-year follow-up shows the feasibility and durable effect of generic ARV in patients living in low-resource settings. The low rate of lost-to-follow-up directly confirms an overall good adherence to HAART. Survival analysis suggests an emerging role of haemoglobin and body weight as predictors of mortality and markers of the general health status.

Keywords: HAART; developing countries; survival