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

TREATMENT OUTCOMES OF NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR (NNRTI)-BASED COMBINATION THERAPY IN THAI MTCT-PLUS PATIENTS FOLLOWED UP WITH LOW-COST TOOL: RESULTS AT 12 MONTHS.

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuOa0306

Phanuphak N., Apornpong T., Teeratakulpisarn S., Phanuphak P.
The Thai Red Cross AIDS Research Centre, Bangkok, Thailand

INTRODUCTION: MTCT-Plus program provides life-long holistic cares to HIV-infected families including antiretroviral treatment when eligible. Only immunologic and clinical data were used to monitor treatment efficacy. Multidisciplinary care teams includes physicians, nurses, counselors, social workers, pharmacists, nutritionists and people living with HIV/AIDS volunteers.

METHODS: Enrollment started with HIV-infected pregnant and postpartum women following by their male partners and children. NNRTI-based combination therapy (AZT or d4T/3TC/NVP or EFV) were prescribed when eligible. Readiness and adherence to medications were assessed at each clinic visit before and during treatment. CD4 count was checked every 6 months. Patients were assessed clinically at week 2, 4, 6, 8 then every 2 months. Telephone calls were used to assess side effects and support adherence at week 1, 3, 5, 7 and month 3 and 5. Therapeutic failure was defined using immunologic combined with clinical criteria.

RESULTS: Among 143 antiretroviral-naïve adults who completed 12 months of antiretroviral therapy, 69.2% were female. The first regimens prescribed were AZT/3TC/NVP in 48.3%, AZT/3TC/EFV in 1.4%, d4T/3TC/NVP in 49.7% and d4T/3TC/EFV in 0.7%. Mean adherence to medication was 99.4% with 96.5% had >95% adherence. Median CD4 at baseline, 6 and 12 months were 136.0, 218.5 and 241.0 cells/mm³ (p<0.001). Therapeutic failure occurred in 2.8% and 0.7% at 6 and 12 months respectively. 9.1% changed to d4T from AZT mostly due to anemia and 9.1% changed to EFV from NVP mostly due to rash/TB. With small number of therapeutic failure, we did not find gender, medication side effect, treatment regimen, baseline CD4 or adherence rate to be risk factor.

CONCLUSIONS: MTCT-Plus model of care in the setting of developing country, using strong adherence support provided by highly effective teamwork and low-cost follow-up tool, provides very high adherence rate among patients receiving NNRTI-based combination therapy along with significant improvement in CD4 counts over 12 months.

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050724
Prevention | TuOa0306 | Nittaya Phanuphak
MTCT-Plus

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