Long-term clinical, immunological and virological outcomes of patients on antiretroviral therapy in southern Myanmar

To study the long-term clinical, immunological and virological outcomes among people living with HIV on antiretroviral therapy (ART) in Myanmar. A 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...

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Published in:	PloS one Vol. 13; no. 2; p. e0191695
Main Authors:	Bermúdez-Aza, Elkin Hernán, Shetty, Sharmila, Ousley, Janet, Kyaw, Nang Thu Thu, Soe, Theint Thida, Soe, Kyipyar, Mon, Phyu Ei, Tun, Kyaw Tin, Ciglenecki, Iza, Cristofani, Susanna, Fernandez, Marcelo
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 08-02-2018 Public Library of Science (PLoS)
Subjects:	Adult Analysis Anti-HIV Agents - therapeutic use Antiviral agents Biology and Life Sciences Care and treatment CD4 Lymphocyte Count Cross-Sectional Studies Female HIV Infections - drug therapy HIV Infections - immunology HIV Infections - virology Humans Immunodeficiency Male Medicine and Health Sciences Middle Aged Myanmar People and Places Retrospective Studies Risk Factors Treatment outcome Viral Load Young Adult Myanmar
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Summary:	To study the long-term clinical, immunological and virological outcomes among people living with HIV on antiretroviral therapy (ART) in Myanmar. A 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. Of 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. Appropriate 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0191695