Abstract
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. 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. 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). Maintaining viral load suppression over time in resource-limited-settings is feasible.
Highlights
There has been increasing interest in the role of “treatment as prevention” (TasP)
82 (13.2%) corresponded to individuals who were diagnosed with HIV in the preHAART era
The majority of our pre-highly active antiretroviral therapy (HAART) cohort consisted of men (n = 69, 84.2%)
Summary
There has been increasing interest in the role of “treatment as prevention” (TasP). 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. Results: Of 619 patients on follow-up, 82 (13.2%) were diagnosed in the pre-HAART era. Conclusions: Maintaining viral load suppression over time in resource-limited-settings is feasible. Studies have repeatedly shown that viral load is the strongest predictor of HIV transmission in any setting [9,10,11]. The potential role of antiretroviral agents to decrease HIV transmission has been an area of much scientific interest. Strong proof of concept of the effectiveness of the preventive role of HAART has been shown in studies of vertical transmission [9,14], HIVserodiscordant couples [10,11,15,16], and at the community level [17,18,19,20]. Increasingly supporting the notion that expansion of HAART coverage represents an invaluable tool to curb the growth of HIV and AIDS [21]
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