Abstract
ObjectiveTo study the long-term clinical, immunological and virological outcomes among people living with HIV on antiretroviral therapy (ART) in Myanmar.MethodsA retrospective analysis of people on ART for >9 years followed by a cross-sectional survey among the patients in this group who remained on ART at the time of the survey. Routinely collected medical data established the baseline clinical and demographic characteristics for adult patients initiating ART between 2004 and 2006. Patients remaining on ART between March-August 2015 were invited to participate in a survey assessing clinical, virological, immunological, and biochemical characteristics.ResultsOf 615 patients included in the retrospective analysis, 35 (6%) were lost-to-follow-up, 9 (1%) were transferred, 153 died (25%) and 418 (68%) remained active in care. Among deaths, 48 (31.4%) occurred within 3 months of ART initiation, and 81 (52.9%) within 12 months, 90.1% (n = 73) of which were initially classified as stage 3/4. Of 385 patients included in the survey, 30 (7.7%) were on second-line ART regimen; 373 (96.8%) had suppressed viral load (<250 copies/ml). The mean CD4 count was 548 cells/ mm3 (SD 234.1) after ≥9 years on treatment regardless of the CD4 group at initiation. Tuberculosis while on ART was diagnosed in 187 (48.5%); 29 (7.6%) had evidence of hepatitis B and 53 (13.9%) of hepatitis C infection.ConclusionsAppropriate immunological and virological outcomes were seen among patients on ART for ≥9 years. However, for the complete initiating cohort, high mortality was observed, especially in the first year on ART. Concerning co-infections, tuberculosis and viral hepatitis were common among this population. Our results demonstrate that good long-term outcomes are possible even for patients with advanced AIDS at ART initiation.
Highlights
The scale up of anti-retroviral therapy (ART) in low and middle income countries (LMIC) for patients with acquired immune deficiency syndrome (AIDS) occurred in 2001–02, following the availability of generic antiretroviral drugs and roll-out of free ART programs [1]
48 (31.4%) occurred within 3 months of ART initiation, and 81 (52.9%) within 12 months, 90.1% (n = 73) of which were initially classified as stage 3/4
Appropriate immunological and virological outcomes were seen among patients on ART for !9 years
Summary
The scale up of anti-retroviral therapy (ART) in low and middle income countries (LMIC) for patients with acquired immune deficiency syndrome (AIDS) occurred in 2001–02, following the availability of generic antiretroviral drugs and roll-out of free ART programs [1]. Long-term cohort data from these settings has become available only recently. Latest data shows that long-term survival of ART patients from some LMIC have results that fall between those found in high-income countries and sub-Saharan countries [2]. Treatment outcomes and viral load (VL) results after >5 years of ART remain largely unknown in an LMIC context, as well as information about adverse metabolic complications commonly classified among the non-AIDS-defining events (NADEs) [5]. Research from well-resourced settings showed that among HIV-infected persons with high CD4+ cell counts, serious NADEs occur more frequently and are associated with a greater mortality risk compared to AIDS-defining events [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
