Treatment as prevention in resource-limited settings: is it feasible to maintain HIV viral load suppression over time?

  • María Eugenia Socías Sanatorio Otamendi, Buenos Aires, Argentina
  • Flavio Rotryng Sanatorio OtamendiSanatorio Otamendi, Buenos Aires, Argentina
  • Pablo Lapadula Sanatorio Otamendi, Buenos Aires, Argentina
  • Maira Medrano Sanatorio Otamendi, Buenos Aires, Argentina
  • Daniela Paz Sanatorio Otamendi, Buenos Aires, Argentina
  • Liliana Stern Sanatorio Otamendi, Buenos Aires, Argentina
  • Alberto Lambierto Sanatorio Otamendi, Buenos Aires, Argentina
  • Daniel Pryluka Sanatorio Otamendi, Buenos Aires, Argentina

Abstract

Introduction: Recently, there has been increasing interest in the role of “treatment as prevention” (TasP). Some of the questions regarding TasP strategies arise from the perceived difficulties in achieving and maintaining viral load (VL) suppression over time and the risk of emergence of viral resistance that could compromise future treatment options. This study was conducted to assess these questions in a resource-limited setting.

Methodology: We performed a retrospective observational study of HIV-infected patients diagnosed in the pre-HAART era on follow-up at a private center from Buenos Aires, Argentina. Socio-demographic, clinical, and laboratory data were extracted from clinical charts. Analyses were performed to test for potential associations of selected variables with current virologic failure or use of third-line drugs.

Results: Of 619 patients on follow-up, 82 (13.2%) were diagnosed in the pre-HAART era. At the time of our study, 79 (96.3%) patients were on HAART, with a median duration of 14 years (IQR 12–15) of therapy, and exposure to mono or dual nucleoside reverse transcriptase inhibitors regimens in 47.8% of cases. Sixty-nine patients (87.3%) had undetectable VL, 37 (46.8%) never presented virologic failure, and 19 (24.1%) experienced only one failure. Thirteen patients (16.5%) were receiving third-line ART regimens, with an average of 2.7-fold more virologic failures than those on first- or second-line regimens (p = 0.007).

Conclusions:  Maintaining viral load suppression over time in resource-limited-settings is feasible.

Published
2013-08-15
How to Cite
Socías M, Rotryng F, Lapadula P, Medrano M, Paz D, Stern L, Lambierto A, Pryluka D (2013) Treatment as prevention in resource-limited settings: is it feasible to maintain HIV viral load suppression over time?. The Journal Of Infection In Developing Countries 7 (08): 593-599. https://doi.org/10.3855/jidc.2926
Section
Original Articles

Keywords

HIV; antiretroviral therapy; viral suppression; Argentina