3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

GENERIC DRUGS, HEALTH DELIVERY MODE AND EFFECTIVENESS OF HAART IN BRAZIL

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. MoOa0204

May S.¹, Barroso P.¹, Santoro Lopes G.¹, Nunes E.¹, Barcaui H.², Costa M.², Almeida M.¹, Faulhaber J.¹, Schechter M.^1
1Projeto Praça Onze, Univ. Federal do Rio de Janeiro, Rio de Janeiro, Brazil, ²Univ. Federal do Rio de Janeiro, Rio de Janeiro, Brazil

INTRODUCTION: Virologic response at 6 months of HAART is an important predictor of long-term efficacy. In Brazil, virtually all HIV-infected individuals receive drugs from the government, for free, including generic drugs, irrespective of where care is provided (public or private). All generic drugs used are locally manufactured. The objective of the study was to evaluate the effectiveness of HAART in Rio de Janeiro, and the predictors of virologic failure (VF) after 6 months on therapy.

METHODS: A retrospective cohort study among drug-naïve patients who initiated HAART between 1996-2004 and who had information on plasma viral load after 6 months on HAART. Chart reviews were conducted in three settings: public health outpatient unit (PHU), a clinical trials unit (CTU) and a private practice (PP).

RESULTS: 485 subjects were included, 308 (64%) men and 177 (36%) women; 354 (73%), 55 (11%) and 76 (16%), were seen at PHU, PP and CTU, respectively. Mean age at HAART initiation was 38 years (SD=11 years). Mean CD4 count and median plasma viral load at baseline were 185 cells/µL (SD=129) and 82,550 copies/µL, respectively. Initial regimens contained a NNRTI in 258 (53%), a PI in 211(44%), triple nucleosides in 10 (2%), and PI/ NNRTI in 6 (2%). VF was observed in 119 (25%) of the subjects. VF occurred among 104 (29%), 3 (6%) and 12 (15%) of the subjects treated at PHU, PP and CTU, respectively. VF was associated with lower baseline CD4 count (median 114 vs. 193, p<0.01), higher baseline viral load (mean 5.02 vs. 4.50, p<0.01), therapy started before 2000 (OR=2.71, 95% CI =1.75-4.2) and use of PI versus NNRTI (OR=1.48; 95% CI=1.2-1.8).

CONCLUSIONS: This study demonstrates the effectiveness of HAART in a developing country setting where generic drugs are widely used, irrespective of the mode of health care delivery.

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Models of treatment and care in diverse settings

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