[MoOrB1095] Antiretroviral therapy in primary health care centers in a South African township

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] Antiretroviral therapy in primary health care centers in a South African township

[AUTHOR(S):] T Kasper, K Hilderbrand, N Tshabane, F Louis, H Reuter, V Labatala, E Goemaere¹, D Coetzee²

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoOrB1095

BACKGROUND: In May 2001, Médecins Sans Frontières added highly-active antiretroviral therapy (HAART) to a package of services available in dedicated HIV clinics at three government-run primary health care (PHC) centers in Khayelitsha, a poor township of Cape Town, South Africa. Patients with advanced HIV disease (CD4 cell counts <200, WHO stage 3/4) were eligible for the program, the only offering HAART at the PHC level in South Africa.

METHODS: Preliminary analysis on the first 85 patients to start HAART. Additional results on projected 180 enrolled by July to be presented.

RESULTS: Baseline characteristics of the first 85 patients: 67% female, mean age 33, 92% antiretroviral-naïve (8% prior AZT), median baseline CD4 cell count 48 (0 - 199), median baseline HIV RNA 5.20 log₁₀ copies/ml (3.54 - 6.83; NASBA Nuclisens, limit of detection 125 c/ml). 58 began AZT/3TC/NVP, 27 AZT/3TC/EFV. HAART led to considerable drop in incidence of opportunistic infections (OIs) (4.4 new OIs/patient-year prior to initiation of HAART vs. 1.2 new OIs/patient-year following initiation). Of the 32 who have been on HAART for 6 months, HIV RNA <125 in 24/26 analyzed (92%), mean CD4 cell increase 128 (n=28), mean weight gain 8 kg (n=29). Therapy was effective both in very severely immunocompromised patients (baseline CD4 cell counts <10: 7/8 HIV RNA <125, mean CD4 cell increase 140) and in those with very high baseline HIV RNA (baseline HIV RNA >=6 log₁₀: 8/8 <125, mean CD4 cell increase 102). Side effects were minimal, with 45% of patients reporting at least one, 87% of which were Grade 1, while lab abnoralities were detected in 48% (54% Gr 1); 8 patients switched therapy for intolerance.

CONCLUSIONS: Preliminary results strongly suggest that antiretroviral therapy can be successfully used in a resource-poor setting, even in patients with very advanced disease. These results support calls to expand access to antiretroviral therapy in developing countries.

Presenting author: T Kasper; Médecins Sans Frontières, Sea Point, South Africa

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1T Kasper, K Hilderbrand, N Tshabane, F Louis, H Reuter, V Labatala, E Goemaere; Médecins Sans Frontières, Sea Point, South Africa

2 D Coetzee; University of Cape Town, Cape Town, South Africa

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