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Potent ART Is Effective in Resource-Poor Countries

Three-drug ART given to poor urban AIDS patients in Haiti yielded results similar to those seen in the U.S.

In developed countries, antiretroviral therapy (ART) has dramatically improved survival for HIV-infected patients. However, 90% of the world’s 40 million HIV-infected individuals live in developing nations, where access to ART and laboratory monitoring is limited, and malnutrition and coinfection with TB and tropical diseases are common. Can ART’s success be duplicated in such settings?

To find out, researchers studied outcomes among 910 adults and adolescents and 94 children who received three-drug ART at a clinic in Port-au-Prince, Haiti. Treatment was initiated in adults and adolescents based on a CD4-cell count <200/mm³ or the presence of an AIDS-defining illness, and in children based on WHO guidelines. Most patients received efavirenz (or, for children <3 years, nevirapine), zidovudine, and lamivudine. Each month, patients were clinically assessed by a nurse, and medications were dispensed.

At 1-year follow-up, adults and adolescents showed a median CD4-count increase of 163 cells/mm³ and a median weight gain of 5.5 kg; responses were similar in children. Viral load was <400 copies/mL in 76 of 100 patients tested. One-year survival rates were 87% in adults and adolescents and 98% in children. ART regimen changes, most often due to drug toxicity or disruption of the medication supply, were necessary for 25% of adults and adolescents and 10% of children.

Comment: These researchers showed that in urban areas of resource-poor countries, ART can produce outcomes comparable to those seen in the U.S. Remarkably, the annual cost per patient for all aspects of care in this study was only $1600. Long-term follow-up is required to assess treatment failure over time. However, these findings clearly support international efforts to supply ART to AIDS patients in the developing world.

— Neil M. Ampel, MD

Published in Journal Watch Infectious Diseases December 9, 2005

Citation(s):

Severe P et al. Antiretroviral therapy in a thousand patients with AIDS in Haiti. N Engl J Med 2005 Dec 1; 353:2325-34.

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