Mortality associated with discordant responses to antiretroviral therapy in resource-constrained settings

Suely Hiromi Tuboi, Antonio Guilherme Pacheco, Lee H. Harrison, Roslyn A. Stone, Margaret May, Martin W G Brinkhof, François Dabis, Matthias Egger, Denis Nash, David Bangsberg, Paula Braitstein, Constantin T. Yiannoutsos, Robin Wood, Eduardo Sprinz, Mauro Schechter*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

38 Citations (Scopus)


OBJECTIVES: We assessed mortality associated with immunologic and virologic patterns of response at 6 months of highly active antiretroviral therapy (HAART) in HIV-infected individuals from resource-limited countries in Africa and South America. METHODS: Patients who initiated HAART between 1996 and 2007, aged 16 years or older, and had at least 1 measurement (HIV-1 RNA plasma viral load or CD4 cell count) at 6 months of therapy (3-9 month window) were included. Therapy response was categorized as complete, discordant (virologic only or immunologic only), and absent. Associations between 6-month response to therapy and all-cause mortality were assessed by Cox proportional hazards regression. Robust standard errors were calculated to account for intrasite correlation. RESULTS: A total of 7160 patients, corresponding to 15,107 person-years, were analyzed. In multivariable analysis adjusted for age at HAART initiation, baseline clinical stage and CD4 cell count, year of HAART initiation, clinic, occurrence of an AIDS-defining condition within the first 6 months of treatment, and discordant and absent responses were associated with increased risk of death. CONCLUSIONS: Similar to reports from high-income countries, discordant immunologic and virologic responses were associated with intermediate risk of death compared with complete and no response in this large cohort of HIV-1 patients from resource-limited countries. Our results support a recommendation for wider availability of plasma viral load testing to monitor antiretroviral therapy in these settings. Copyright © 2009 by Lippincott Williams & Wilkins.

Original languageEnglish
Pages (from-to)70 - 77
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number1
Publication statusPublished - Jan 2010

Bibliographical note

Other: PM:19531926


  • Antiretroviral therapy
  • CD4 lymphocyte count
  • Cohort
  • Highly active
  • Low-income population
  • Mortality
  • Treatment outcome
  • Viral load


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