부산대학교 도서관

Early and current HAART drug combinations' efficacy is comparable but pill burden and tolerability are strikingly different. Demographic, biological and virological aspects of an early and late cohort from the HAART era were evaluated, focusing on time to failure and percentage of undetectable at first year of treatment. Retrospective observational study of two HIV reactive patients cohorts clustered by the year starting their first HAART; cohort 1 from January 1996 to June 2003; cohort 2 from July 2003 to January 2011. Standarized collected data from clinical records were median age of diagnosis, sex, CDC stage category, median CD4+ count at the time of starting treatment, percentage of patients failing their first HAART, time to failure and percentage of undetectable at the first year of treatment. Exclusion criteria: lack of viral load at the first year of initial HAART and loss of patient following. Evaluation of adherence: number of absences to scheduled appointments, number of pills dispensed per patient and accomplishment self-reporting. Taking less than 90% pills in a month was considered as low adherence. Virological rebound was defined as two successive viral loads >50 copies of HIV-1 RNA/ml after one detection of a viral load <50 copies/ml. A percentage analysis was applied to biological and demographic variables, x2 test was implemented when comparing cohorts. From 958 clinical records, 215 were eligible for the study. Cohort 1 enrolled 84 patients; cohort 2, 131. Table 1 compares demographic, biologic and virological variables. Median CD4+ count when starting first HAART showed no significant difference between groups: 254 and 235 cells/ml; group 2, 235 cells/ml. Failure to first treatment: cohort 1, 38 (45%); cohort 2, 17 (13%). Mean time to failure: 118 and 94 weeks in cohort 1 and 2 respectively (p 0.13). Percentage of undetectable at the first year of treatment: cohort 1, 84%; cohort 2, 82% (p 0.34). This comparison shows that drugs prescribed in early HAART era were equipotent with current ones, since neither the percentage of undetectable at the first year of treatment nor the time to failure showed significant differences. On the contrary, the percentage of failures at any time was significantly higher in cohort 1, mainly because of adverse effects and intolerance. Low CD4 count in both groups indicates a delayed diagnosis. Offering the HIV screening test to the whole community is the remaining challenge. [ABSTRACT FROM AUTHOR]