Associated factors to virologic result on Highly Active Antiretroviral Therapy (HAART) in 340 naive patients. Medellín - Colombia, 1997 - 2000
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Abstract
Context: Most studies supporting guidelines on HIV/AIDS have been conducted in developed countries. Nevertheless, their applicability on effectiveness of therapies may vary in developing countries, because of different socioeconomic characteristics which can affect therapy responses.
Objective: To measure HAART effectiveness and factors associated with favorable virologic responses after six months of treatment.
Study design: Historical Cohort.
Place: Public Hospital with ambulatory service for HIV/AIDS patients in a developing country (Medellín, Colombia). May 1997 trough May 2000.
Patients: 340 naive patients, over 13 years of age, which began HAART theraphy.
Measurements: The dependent variable was the viral load after six months of therapy, classified as a result either over or below 500 copies/ml. Univariate analysis was conducted using odds ratios for categorical variables and student – t test for quantitative ones. Logistic regression was used in order to identify adjusted risk factors of confounding factors.
Results: 56% of patients reached a viral load of less than 500 copies/ml after six months of therapy. This effectiveness level was obtained for HIV positive and AIDS patients (56.3% and 59.5% respectively) and independently of CD4 T cells level and viral load level before the beginning of the therapy. In the multivariate analysis no – adherence to therapy (OR 51.73 95% CI 21.22 – 126.11) and age below 34 years (OR 3.13 95% CI 1.47 – 6.66) were associated with a viral load higher than 500 copies/ml after six months of therapy. 66.8% of patients reported adherence to therapy and 80.2% of them succeeded with therapy, in non adherent patients 89.9% failed to reach viral load control. Median of CD4 T cells increase was 95 cells/ml and the reduction of viral load was -1.52 Log10 after 6 months of therapy.
Conclusions: Viral load control in naive patients after 6 months of therapy is comparable with cohorts from developed countries and this effect was independent of clinical stage (AIDS or Asymptomatic), CD4 T cells level, or viral load previous to therapy. Ages higher than 34 years and therapy adherence were factors positively associated with viral load control. This study suggests different effect of therapy, than cohorts with a mix of naive and experimented patients. Self reported adherence is associated with virologic load control, for that reason, efforts can be directed to improve this response.
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References
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