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Background:  Chile, a country of 15 million people and a middle income, has an HIV epidemic of moderate proportions (global infection rate:  0.2%). Government-sponsored, free, and highly active antiretroviral therapy (HAART) for patients (pt) from the public health system began in 2001. In 2004 HAART coverage reached 100% of known infected public health system pt (about 85% of total infected population in the country). The program uses only original drugs. The Arriaran Foundation (AF) is the largest public AIDS care center for adults in the country.

Methods:  To assess the succes of the public health program to combat AIDS in Chile, this study reviewed the AF population from 1991 to 2004 to document the present status of the disease and the evolution of mortality in AIDS pt.

Results:  As of July 2004, AF has cared for 2162 adult pt, with an admissions rate of 160-to-190 pt annually. The present active AF census is 980 pt. Cumulated global mortality has been 735 out of a population of 2160 (33.5%), and annual mortality has decreased progressively from a maximum of 17.4% of its active population in 1995 to 1.8% in 2003. As of July 2004, 790 (80.6% of total) pt are receiving ART; 39 (5%) are in process of initiation or change; and 152 do not require or do not accept ART. Excluding 59 pt on clinical trials. Six pt groups (a through f) received various combinations of ART treatments: (a) efavirenz (with Combivir®), 42%; (b), stavudine and lamivudine, 6.7%; (c) nevirapine (with Combivir®, 30%), 37%; (d) stadvudine and lamivudine, 3.5%; (e) indinavir (with Combivir® 3.8%), 4%; (e) Kaletra® in various combinations, 6%, and (f) others < 2%. Regimen groups a-d are mainly for treatment-naïve pt. Kaletra® is not used in first line regimens. 65.9% of pt had baseline CD4 count < 200 mm³ (41% < 100) and 50% had clinical AIDS. At last control (various dates and follow up times, but > 3 months of ART), 78.4% had viral load < 400 copies. Undetectability for each group was:  (a) 85.7%; (b) 80.8%; (c) 80%; (d) 75%; (e) 58% (f) 56%; and protocols, 95%. The last CD4 count was < 200 in 40%; 200 to 400 in 40%; and > 500 in 11%.

Conclusion:  Implementation of an expanded access program to ART in a public, comprehensive care center in a middle-income country has been highly successful in reducing mortality and the increasing the viral undetectability rate (~ 80%). These figures are comparable with that of AIDS care centers or clinical trials in developed countries, despite a population with very advanced disease.

Keywords: antiretroviral therapy; developing countries; treatment outcomes