597 
HIV RNA Levels 6 Months after ART Initiation Is a Strong, Independent Predictor of Subsequent Survival in HIV-infected Individuals in Sub-Saharan Africa
M Marazzi1, Andrea De Luca*2, E Buonomo3, M Magnano S Lio4, P Narciso5, S Ceffa4, M Bartolo6, I Zimba Da Vitoria7, L Palombi3, and DREAM Study Group
1LUMSA Univ, Rome, Italy; 2Catholic Univ, Rome, Italy; 3Univ of Tor Vergata, Rome, Italy; 4DREAM program, Rome, Italy; 5National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy; 6S Giovanni Addolorata Hospital, Rome, Italy; and 7DREAM Program Coordination, Maputo, Mozambique
Background: Viral load is
not available for treatment monitoring in most ART programs in Sub-Saharan
Africa. We aimed at investigating the prognostic role of virological response
to ART in patients from 5 DREAM-supported sites in 3 countries undergoing comprehensive
treatment monitoring.
Methods: Naïve patients from
sites in Mozambique, Malawi, and Guinea Konakry starting ART with available
viral load (bDNA, lower limit 50 copies/mL) at around 6 months (12 to 36 weeks)
after treatment initiation and subsequent follow-up were investigated. Baseline
and 6-month CD4 and viral load, baseline WHO stage, hemoglobin, body mass index
and proportion of missed (>7 days delay) pharmacy appointments during follow-up
were also retrieved for analysis. Predictors of time from the 6-month viral
load to death were analyzed by Cox regression models. Follow-up was
right-censored at last clinical visit.
Results: We analyzed 1899
patients: 62% female, at baseline median age was 35 years, 28% were on WHO
stage III/IV, median CD4 208 cells/mL, viral
load 4.6 log10 copies/mL, hemoglobin 10.8 g/dL, body mass index 20.6
kg/m2. Most frequently employed regimens were stavudine (d4T) or zidovudint
(ZDV) + lamivudine (3TC) + nevirapine (NVP) (97%); 18 % missed ≥5% drug
pick-up appointments. At 6 months, 84.8 % had viral load <1,000 copies/mL
and median CD4 change was +118 cells/mL.
After month 6 viral load, during a cumulative follow-up of 2356 person-years,
74 patients died, 46 were lost to follow-up. Predictors of time-to-death are
summarized in the table. In a sensitivity analysis, when the multivariable
model was additionally adjusted for WHO stage, HIV RNA >10,000 copies/mL
remained independently predictive of death (vs <50 copies/mL, HR 3.97, 1.75
to 8.00, p = 0.001).
Conclusions: In a Sub-Saharan
African setting, achieving an HIV RNA <10,000 copies/mL at 6 months (12 to 36
weeks) after ART initiation is a strong, independent predictor of subsequent survival.
Other independent predictors are higher CD4 at 6 months, baseline hemoglobin, female
sex, and adherence to pharmacy appointments.
|
