Long-term Experience and Outcomes of Programmatic Antiretroviral Therapy for Human Immunodeficiency Virus Type 2 Infection in Senegal, West Africa.
90-90-90
HIV treatment
HIV-2
antiretroviral therapy
viral suppression
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
01 02 2021
01 02 2021
Historique:
received:
03
12
2019
accepted:
12
03
2020
entrez:
2
2
2021
pubmed:
3
2
2021
medline:
29
4
2021
Statut:
ppublish
Résumé
Programmatic treatment outcome data for people living with human immunodeficiency virus type 2 (HIV-2) in West Africa, where the virus is most prevalent, are scarce. Adults with HIV-2 initiating or receiving antiretroviral therapy (ART) through the Senegalese national AIDS program were invited to participate in this prospective, longitudinal observational cohort study. We analyzed HIV-2 viral loads, CD4 cell counts, antiretroviral drug resistance, loss to follow-up, and mortality. We also examined changes in treatment guidelines over time and assessed progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets for HIV-2. We enrolled 291 participants at 2 sites for 926.0 person-years of follow-up over 13 years. Median follow-up time was 2.2 years per participant. There were 21 deaths reported (7.2%), and 117 individuals (40.2%) were lost to follow-up, including 43 (14.7%) who had an initial visit but never returned for follow-up. CD4 counts and HIV-2 viral suppression (< 50 copies/mL) at enrollment increased over calendar time. Over the study period, 76.7% of plasma viral loads for participants receiving ART were suppressed, and median CD4 gain was 84 cells/μL in participants' first 2 years on study. Since the UNAIDS 90-90-90 strategy was published, 88.1% of viral loads were suppressed. Fifteen percent of patients experienced virologic failure with no known resistance mutations, while 56% had evidence of multiclass drug resistance. Participants in the Senegalese national AIDS program are initiating ART earlier in the course of disease, and more modern therapeutic regimens have improved outcomes among those receiving therapy. Despite these achievements, HIV-2 treatment remains suboptimal, and significant challenges to improving care remain.
Sections du résumé
BACKGROUND
Programmatic treatment outcome data for people living with human immunodeficiency virus type 2 (HIV-2) in West Africa, where the virus is most prevalent, are scarce.
METHODS
Adults with HIV-2 initiating or receiving antiretroviral therapy (ART) through the Senegalese national AIDS program were invited to participate in this prospective, longitudinal observational cohort study. We analyzed HIV-2 viral loads, CD4 cell counts, antiretroviral drug resistance, loss to follow-up, and mortality. We also examined changes in treatment guidelines over time and assessed progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets for HIV-2.
RESULTS
We enrolled 291 participants at 2 sites for 926.0 person-years of follow-up over 13 years. Median follow-up time was 2.2 years per participant. There were 21 deaths reported (7.2%), and 117 individuals (40.2%) were lost to follow-up, including 43 (14.7%) who had an initial visit but never returned for follow-up. CD4 counts and HIV-2 viral suppression (< 50 copies/mL) at enrollment increased over calendar time. Over the study period, 76.7% of plasma viral loads for participants receiving ART were suppressed, and median CD4 gain was 84 cells/μL in participants' first 2 years on study. Since the UNAIDS 90-90-90 strategy was published, 88.1% of viral loads were suppressed. Fifteen percent of patients experienced virologic failure with no known resistance mutations, while 56% had evidence of multiclass drug resistance.
CONCLUSIONS
Participants in the Senegalese national AIDS program are initiating ART earlier in the course of disease, and more modern therapeutic regimens have improved outcomes among those receiving therapy. Despite these achievements, HIV-2 treatment remains suboptimal, and significant challenges to improving care remain.
Identifiants
pubmed: 33527119
pii: 5813599
doi: 10.1093/cid/ciaa277
pmc: PMC7850514
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
369-378Subventions
Organisme : NIAID NIH HHS
ID : R01 AI060466
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI120765
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI068636
Pays : United States
Investigateurs
Fatou Traore
(F)
Samba Cisse
(S)
Ousseynou Ndiaye
(O)
Babacar Faye
(B)
Fatou Simal
(F)
Ndeye Astou Diop
(N)
Amadou Bale Diop
(A)
Marianne Fadam Diome
(M)
Juliette Gomis
(J)
Therese Dieye
(T)
Noelle Benzekri
(N)
John Lin
(J)
Donna Kenney
(D)
Alison Starling
(A)
Cathy Critchlow
(C)
Steve Cherne
(S)
Jennifer Song
(J)
Robbie Nixon
(R)
Pallas Burhen
(P)
Chris Zavala
(C)
Vincent Wu
(V)
Sara Masoum
(S)
Sally Leong
(S)
Alex Montano
(A)
Mariah Oakes
(M)
Julia Olson
(J)
Lindsey Blankenship
(L)
Charlotte Pan
(C)
Kara Parker
(K)
Kate Parker
(K)
Alex Hernandez
(A)
Brad Church
(B)
Moon Kim
(M)
Paul Lu
(P)
Stefanie Sorensen
(S)
Kim Wong
(K)
James Mullins
(J)
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
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