Longer term clinical and virological outcome of sub-Saharan African participants on antiretroviral treatment in the Swiss HIV Cohort Study

Publication

Longer term clinical and virological outcome of sub-Saharan African participants on antiretroviral treatment in the Swiss HIV Cohort Study

Journal Paper/Review - Jan 1, 2012

Staehelin Cornelia, Furrer Hansjakob, Bernasconi Enos, Schmid Patrick, Cavassini Matthias, Elzi Luigia, Weber Rainer, Calmy Alexandra, Keiser Olivia, Swiss HIV Cohort Study

Citation

Staehelin C, Furrer H, Bernasconi E, Schmid P, Cavassini M, Elzi L, Weber R, Calmy A, Keiser O, Swiss HIV Cohort Study. Longer term clinical and virological outcome of sub-Saharan African participants on antiretroviral treatment in the Swiss HIV Cohort Study. J Acquir Immune Defic Syndr 2012; 59:79-85.

Type

Journal Paper/Review (English)

Journal

J Acquir Immune Defic Syndr 2012; 59

Publication Date

Jan 1, 2012

Issn Electronic

1944-7884

Pages

79-85

Brief description/objective

OBJECTIVES
Persons from sub-Saharan Africa (SSA) are increasingly enrolled in the Swiss HIV Cohort Study (SHCS). Cohorts from other European countries showed higher rates of viral failure among their SSA participants. We analyzed long-term outcomes of SSA versus North Western European participants.

DESIGN
We analyzed data of the SHCS, a nation-wide prospective cohort study of HIV-infected adults at 7 sites in Switzerland.

METHODS
SSA and North Western European participants were included if their first treatment combination consisted of at least 3 antiretroviral drugs (cART), if they had at least 1 follow-up visit, did not report active injecting drug use, and did not start cART with CD4 counts >200 cells per microliter during pregnancy. Early viral response, CD4 cell recovery, viral failure, adherence, discontinuation from SHCS, new AIDS-defining events, and survival were analyzed using linear regression and Cox proportional hazard models.

RESULTS
The proportion of participants from SSA within the SHCS increased from 2.6% (<1995) to 20.8% (2005-2009). Of 4656 included participants, 808 (17.4%) were from SSA. Early viral response (6 months) and rate of viral failure in an intent-to-stay-on-cART approach were similar. However, SSA participants had a higher risk of viral failure on cART (adjusted hazard ratio: 2.03, 95% confidence interval: 1.50 to 2.75). Self-reported adherence was inferior for SSA. There was no increase of AIDS-defining events or mortality in SSA participants.

CONCLUSIONS
Increased attention must be given to factors negatively influencing adherence to cART in participants from SSA to guarantee equal longer-term results on cART.