Background:  Provision of HIV care and treatment, including ART, to patients (pt) in resource-limited countries (RLC) has received recent attention. However, limited longitudinal data are available on response to ART. We assessed response to ART in pt enrolled in the mother-to-child HIV transmission-plus (MTCT+) Initiative, a comprehensive HIV program active in 8 countries in Sub-Saharan Africa and Thailand. MTCT+ focuses on HIV positive (HIV ante- and postpartum women, their HIV positive partners, and infected children.

Methods:  Baseline demographic information, weight, and CD4⁺ cell count were assessed. Eligible adult pt for this analysis required baseline and 6 months CD4⁺ cell count, as well as 6 months of continuous ARV.  Pregnant women were excluded from analyses of weight.  Repeated measures ANOVA was used to evaluate the changes over time.

Results:  MTCT-Plus enrolled 3352 adults as of July 2004. ARV were prescribed to 1017 (30.3%) pt; 226 pt were eligible for analysis: 155 (69%) women, of whom 80 (52%) were pregnant when starting therapy. Characteristics of the cohort: mean age 31 years, World Health Organization (WHO) stage at baseline I = 88 (39%), II = 62 (27.4%), III = 64 (28.3%), IV = 12 (5.3%), median CD4⁺ count 150 cells/mm³ (IQR 85 to192) [women baseline CD4⁺ count 150 cells/mm³ (IQR 91-193), men baseline CD4⁺ cell count 147 cells/mm³ (IQR 85 to 189)], and mean weight 59kg (IQR 52 to 64 ). At 6 months follow up (n = 226), median CD4⁺ count increased to 265 cells/mm³ (IQR 187 to 360) (p < 0.0001) and weight (n = 145) to 61 kg (IQR 54 to 67kg) (p < 0.0001). Mean change in CD4 cell count in women was 148 cells/mm³ and in men 107 cell/mm³ (p < 0.006). The change in CD4 over time does not differ significantly by WHO stage at baseline (p = 0.2835).

Conclusions:  Longitudinal data indicate that pt enrolled from multiple sites in RLC had favorable response to ARV. The CD4⁺ cell count response is consistent with that noted in studies from RLC and resource-rich country settings. Women had a more favorable response that may reflect better ART adherence or programmatic elements particularly supportive of women.

Keywords: MTCT-Plus; Resource Limited Countries; HIV Care and Treatment